A Random Forest machine learning model predicted 1-year arrhythmic recurrence following pulsed field ablation for atrial fibrillation with an AUC of 0.75 (95% CI 0.69-0.82).
Cohort (n=1,688)
Can machine learning models accurately predict 1-year arrhythmic recurrence in atrial fibrillation patients undergoing pulsed field ablation?
A machine learning model can predict 1-year arrhythmic recurrence after pulsed field ablation for atrial fibrillation, identifying diagnosis-to-ablation time, BMI, and indexed left atrial volume as major predictors to help optimize patient selection.
Effect estimate: AUC 0.75 (95% CI 0.69-0.82)
Abstract Background Despite being the most effective option for maintaining sinus rhythm, atrial fibrillation (AF) catheter ablation reaches few patients. For this reason, identifying candidates with the highest likelihood of success or individualizing counselling to a specific patient to improve procedural outcome could enhance clinical benefits and cost-effectiveness. Objective To integrate machine learning (ML) into an outcome prediction model based on a large cohort of AF patients undergoing pulsed field ablation (PFA). Methods Consecutive AF patients undergoing transcatheter PFA between June 2022 and December 2024 were prospectively enrolled in the ATHENA registry. All procedures were performed with a penta-splines 12F over-the-wire PFA catheter (FARAWAVE™, Boston Scientific). Clinical and procedural variables were collected to train five predictive models estimating 1 year arrhythmic recurrence; model interpretability was assessed using SHAP (SHapley Additive exPlanations) analysis. Results The study included 1688 AF patients with a median follow-up of 365 days (interquartile range 202-393), arrhythmic recurrence occurred in 314 patients (18.6%). The Boruta algorithm identified diagnosis-to-ablation time (DAT), CHA₂DS₂-VASc score, age, and body mass index (BMI) as most significant predictors. Among the five ML models developed to predict 1 year arrhythmic recurrence probability, Random Forest achieved the best performance (AUC = 0.75, 95% CI 0.69-0.82). SHAP analysis confirmed DAT, BMI, and indexed left atrial volume as major contributors to recurrence. Conclusion This is the first ML model exclusively trained and validated on AF patients undergoing PFA providing actionable insights for personalized treatment planning. Routine use of the model holds the potential to optimize patient selection and improve procedural outcome, supporting individualized counselling and outcome-driven care pathways, moving from static to interactive risk prediction. Clinical Trial Registration Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/ Identifier: NCT05617456
Anselmino et al. (Wed,) conducted a cohort in Atrial fibrillation (n=1,688). Machine learning prediction model (Random Forest) was evaluated on 1 year arrhythmic recurrence (AUC 0.75, 95% CI 0.69-0.82). A Random Forest machine learning model predicted 1-year arrhythmic recurrence following pulsed field ablation for atrial fibrillation with an AUC of 0.75 (95% CI 0.69-0.82).
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