Multidomain prediction and risk stratification of atrial fibrillation recurrence after catheter ablation in elderly patients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic paroxysmal or persistent non-valvular atrial fibrillation (n=122). Intervention: Early atrial fibrillation recurrence (during the 90-day blanking period) and multidomain risk factors vs. No early recurrence / lower multidomain risk burden. Primary outcome: Late atrial fibrillation recurrence (any documented AF, atrial flutter, or atrial tachycardia episode lasting >= 30 seconds occurring beyond the 90-day blanking period up to 12 months) (HR 2.41, 95% CI 1.43-4.07, p=0.001).

Q: What does this research mean for the field?

An integrated multidomain risk model combining structural, electrical, biomarker, comorbidity, and dynamic post-ablation factors accurately predicts 1-year atrial fibrillation recurrence after catheter ablation in elderly patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

D.T. Malidze; O. S. Sychov; L. D. Dolidze; D. P. Sepiashvili; K. G. Kobiashvili; M. Noniashvili

doi:10.31928/2664-4479-2026.5.5972

October 30, 2026Ukrainian Journal of CardiologyOpen Access

Multidomain prediction and risk stratification of atrial fibrillation recurrence after catheter ablation in elderly patients

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Key result

Early recurrence linked to ~2.4-fold higher 1-year AF recurrence after ablation in elderly patients.

HR 2.41
95% CI 1.43-4.07
P=0.001
n=122

Why the study?

The study aimed to identify independent multidomain predictors of AF recurrence after first-time catheter ablation in elderly patients and develop an integrated risk stratification approach.

Does an integrated multidomain risk stratification model incorporating structural, electrical, biomarker, clinical, and dynamic post-ablation factors predict 12-month AF recurrence in elderly patients undergoing first-time catheter ablation?

Key Points

Identify independent multidomain predictors of atrial fibrillation recurrence after first-time catheter ablation in elderly patients and develop an integrated risk stratification model.
Prospective multicenter study evaluating 122 patients aged ≥ 70 years undergoing first-time catheter ablation for symptomatic atrial fibrillation.
Assessed baseline clinical metrics, CHA2DS2-VASc score, echocardiography with left atrial strain, electrocardiography, 24-hour Holter monitoring, biomarkers, and early recurrence during a 90-day blanking period.
Identified independent predictors using Cox proportional hazards regression and constructed an integrated score evaluated by the C-statistic over 12 months of follow-up.
Late atrial fibrillation recurrence occurred in 53 (43.4%) patients during 12 months of follow-up.
Independent predictors included heart failure, chronic kidney disease, obstructive sleep apnoea, longer arrhythmia duration, elevated NT-proBNP, increased left atrial volume index, reduced left atrial strain, higher premature atrial contraction burden, advanced interatrial block, and early recurrence during the blanking period.
The integrated risk model demonstrated a C-statistic of 0.82, with 12-month recurrence-free survival rates of 80.0% in low-risk, 56.5% in intermediate-risk, and 30.6% in high-risk categories.

Study Design

Type

Cohort (n=122)

Blinding

Experienced echocardiographers blinded to recurrence status

Multicenter

Yes

Structured PICO

Does an integrated multidomain risk stratification model incorporating structural, electrical, biomarker, clinical, and dynamic post-ablation factors predict 12-month AF recurrence in elderly patients undergoing first-time catheter ablation?

P

Population

122 elderly patients (mean age 74.2 years, 45.9% female) with symptomatic paroxysmal or persistent non-valvular atrial fibrillation undergoing first-time catheter ablation in Georgia, followed for 12 months.

E

Exposure

First-time catheter ablation (pulmonary vein isolation using radiofrequency or cryoballoon technique) and risk stratification using an integrated multidomain model (incorporating heart failure, CKD, OSA, AF duration, NT-proBNP, LAVI, LA reservoir strain, PAC burden, advanced interatrial block, and early recurrence during the 90-day blanking period).

C

Comparator

Comparison across low-risk (score 0-3), intermediate-risk (score 4-7), and high-risk (score ≥8) multidomain atrial vulnerability categories, and between patients with vs. without individual risk predictors.

O

Outcome

Late AF recurrence at 12 months, defined as any documented AF, atrial flutter, or atrial tachycardia episode lasting ≥ 30 seconds occurring beyond the 90-day blanking period and confirmed by 12-lead ECG, Holter monitoring, or other clinical rhythm documentation.hard clinical

Main Result

Hazard Ratio: 2.41 (95% CI 1.43–4.07)

Absolute Event Rate: 69.4% vs 20%

p-value: p=0.001

Integrated multidomain assessment combining structural atrial remodeling, electrical instability, systemic comorbidities, NT-proBNP, and early blanking-period recurrence effectively stratifies 1-year AF recurrence risk in elderly patients undergoing first-time catheter ablation (C-statistic 0.82).

Limitations

Relatively modest study population (n=122) and modest number of recurrence events (n=53)
Multivariable modeling and the additive risk score were exploratory and hypothesis-generating
Derived from a single cohort and requires external validation in larger prospective studies before routine clinical implementation
Patients with incomplete baseline or follow-up data were excluded from the final analysis (58 of 180 screened patients excluded)
Relatively modest study population (N=122) and modest number of recurrence events (n=53)
Multivariable modeling and the integrated risk stratification model are exploratory and hypothesis-generating
Lack of external validation; requires validation in larger prospective studies before routine clinical implementation
58 of 180 initially screened patients were excluded due to incomplete baseline evaluation, inability to complete follow-up, withdrawal of consent, or exclusion criteria

Implication

May aid risk stratification after AF ablation in elderly patients; leaves open external validation before clinical adoption.

Abstract

The aim – to identify independent multidomain predictors of atrial fibrillation (AF) recurrence after first-time catheter ablation in elderly patients and to develop an integrated risk stratification approach based on structural, electrical, biomarker, clinical, and dynamic post-ablation factors.Materials and methods. This prospective multicentre study included 122 patients aged ≥ 70 years undergoing first-time catheter ablation for symptomatic AF. Baseline evaluation included clinical assessment, calculation of the CHA2DS2-VASc score, transthoracic echocardiography with left atrial strain analysis, electrocardiography, 24-hour Holter monitoring, and biomarker testing. Early recurrence during the 90-day blanking period was analyzed as a dynamic predictor. Cox proportional hazards regression analysis was used to identify independent predictors of late AF recurrence. Based on the independent predictors, patients were stratified into low-, intermediate-, and high-risk categories.Results. During 12 months of follow-up, AF recurrence occurred in 53 (43.4 %) patients. Independent predictors of recurrence included heart failure, chronic kidney disease, obstructive sleep apnoea, longer AF duration, elevated NT-proBNP, increased left atrial volume index, reduced left atrial strain, higher premature atrial contraction burden, advanced interatrial block, and early recurrence during the blanking period. Based on these predictors, an integrated multidomain risk stratification model was developed, incorporating structural remodeling, electrical instability, systemic comorbidity burden, biomarker-defined myocardial stress, and dynamic post-ablation recurrence. The model demonstrated good discrimination (C-statistic 0.82) and separated patients into low-, intermediate-, and high-risk categories, with recurrence-free survival of 80.0 %, 56.5 %, and 30.6 %, respectively, at 12 months.Conclusions. AF recurrence after catheter ablation in elderly patients reflects cumulative multidomain atrial vulnerability rather than isolated predictors alone. Integrated assessment of structural remodeling, electrical instability, systemic comorbidities, biomarkers, and early post-ablation recurrence may improve risk stratification and individualized follow-up after catheter ablation.

Discussion

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Cite This Study

Malidze et al. (2026) conducted a cohort in Symptomatic paroxysmal or persistent non-valvular atrial fibrillation (n=122). Early atrial fibrillation recurrence (during the 90-day blanking period) and multidomain risk factors vs. No early recurrence / lower multidomain risk burden was evaluated on Late atrial fibrillation recurrence (any documented AF, atrial flutter, or atrial tachycardia episode lasting >= 30 seconds occurring beyond the 90-day blanking period up to 12 months) (HR 2.41, 95% CI 1.43-4.07, p=0.001). An integrated multidomain risk model predicted 1-year AF recurrence after ablation in elderly patients (C-statistic 0.82), with early recurrence as the strongest predictor (HR 2.41, p=0.001).

synapsesocial.com/papers/6ae682bde432e7a5c4ef3702 https://doi.org/10.31928/2664-4479-2026.5.5972

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Multidomain prediction and risk stratification of atrial fibrillation recurrence after catheter ablation in elderly patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Multidomain prediction and risk stratification of atrial fibrillation recurrence after catheter ablation in elderly patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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