Interaction between long-term preoperative beta-blocker therapy and left atrial appendage radiomics in predicting post-ablation atrial fibrillation recurrence

Background It remains unclear whether long-term preoperative pharmacological therapy impacts the predictive value of left atrial appendage (LAA) radiomics for post-ablation atrial fibrillation (AF) recurrence. This study aims to explore the impact of preoperative beta-blocker therapy on an LAA radiomics and clinical features model for predicting post-ablation AF recurrence. Methods Among 707 screened AF patients, 555 met eligibility criteria for this retrospective study. Patients were stratified by preoperative beta-blocker therapy. Baseline clinical and echocardiographic parameters were analyzed. A radiomics score (Rad-score) was calculated based on selected LAA features in the without beta-blocker group and integrated with clinical parameters into a nomogram model. The model performance was compared between groups. To address baseline clinical imbalances, inverse probability of treatment weighting (IPW) was applied. Following IPW adjustment, rad-score and beta-blocker interactions were evaluated via multivariable Cox regression, and Kaplan-Meier analysis assessed 12-month AF recurrence-free survival. Results Overall, 91 (16.4%) patients experienced recurrence. In the without beta-blocker group ( n = 295, including 50 with recurrence), patients with recurrence exhibited reduced lymphocyte counts, elevated body mass index (BMI), and a lower prevalence of diabetes. These three parameters, along with a Rad-score derived from 11 LAA radiomic features, were integrated to develop a prediction nomogram. The model discrimination (Area Under the ROC Curve (AUC) = 0.742) dropped significantly in the with beta-blocker group (AUC = 0.501, P < 0.001). In the IPW-adjusted multivariable Cox analysis, Rad-score predicted recurrence in patients without beta-blocker therapy (Hazard Ratio (HR) = 2.73, P < 0.001), but not in users (HR = 0.91, P = 0.338). Rad-score significantly interacted with beta-blocker use ( P for Interaction < 0.001), successfully stratifying IPW-adjusted recurrence-free survival only in the without beta-blocker cohort (Log-rank P < 0.001). Conclusions To ensure prognostic accuracy, preoperative medication history must be explicitly integrated as a core variable within comprehensive risk stratification models. However, the model requires multicenter external validation to confirm its broader applicability. Trial registration Not applicable.