A Nomogram utilizing ECG P-wave parameters to predict recurrence risk following catheter ablation in paroxysmal atrial fibrillation

Abnormal changes in P-wave parameters indicative of atrial electrical remodeling often manifest earlier than changes in other indicators reflecting atrial structural remodeling in paroxysmal atrial fibrillation. Preoperative absolute values of Maximum P Wave Duration, P Wave Dispersion, and P Wave Terminal Force of V1, as well as postoperative absolute values of Maximum P Wave Duration, P Wave Duration, P Wave Dispersion, P Wave Terminal Force of V1, and P Wave Area, demonstrate strong predictive value for recurrence risk of paroxysmal atrial fibrillation after Catheter Ablation. The nomogram model based on P-wave parameters before and after catheter ablation exhibits notably strong predictive performance and offers significant clinical benefits. The objective of this study is to assess the predictive utility of perioperative P-wave parameters in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation, and to develop a predictive model using these parameters. A total of 213 patients with PAF undergoing catheter ablation were retrospectively analyzed. P-wave parameters were measured within 3 days preoperatively and on the day postoperatively to determine their predictive significance for postoperative PAF recurrence. Post-ablation, PAF did not recur in 168 patients, while 45 experienced recurrence. Significant differences were observed in preoperative P-wave parameters as Maximum P Wave Duration(Pmax), absolute value of P Wave Terminal Force of V1 (PtfV1) and P Wave Dispersion(Pd), postoperative P-wave parameters as P Wave Duration (PWDII, III, aVF), Pmax, P Wave Area(P-area), absolute value of PtfV1 and Pd, and changes in perioperative P-wave parameters (Delta-Pmax, Delta-PtfV1 absolute value, Delta-Pd, Delta-PWDII, III, aVF). Univariate logistic regression, receiver operating characteristic (ROC) curve analysis, and hazard ratio assessment identified predictive indicators for postoperative recurrence, including Pmax, PtfV1 absolute value, Pd, post-P area, post-PWDII, III, aVF and Delta-pwdII, III, aVF). A personalized nomogram model based on these P-wave parameters was developed. Calibration curve assessment demonstrated that the predictive performance of the nomogram for PAF recurrence following catheter ablation closely matched actual observed outcomes. ROC curve analysis indicated a sensitivity of 89.3% for the model, and decision curve analysis confirmed its significantly favorable predictive use and clinical benefits. P-wave parameters like PWDШ, PWDaVF, Pmax, Pd, and PtfV1 serve as predictors of PAF recurrence following catheter ablation. The nomogram model constructed using these P-wave parameters demonstrates robust predictive performance.