Echocardiographic Risk Factors for Atrial Fibrillation Recurrence Following Radiofrequency Catheter Ablation: A Retrospective Analysis

Objective: To assess the value of pre-procedural echocardiography (ECHO) parameters for predicting recurrence following radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) and develop a predictive model. Methods: In this retrospective study of 103 AF patients undergoing first-time RFCA, pre-ablation ECHO parameters were analyzed. The primary endpoint was AF recurrence after 3-month “blanking period”. Independent predictors were identified employing univariate and Firth-penalized multivariate logistic regression. Model performance was evaluated via ROC curve analysis, Bootstrap validation, calibration curves, and decision curve analysis (DCA). A predictive nomogram was generated based on the final model. Results: AF recurrence occurred in 32 patients (31.1%). Univariate analysis revealed that the recurrence group exhibited remarkably greater left atrial diameter (LAD), left atrial volume index (LAVI), mitral inflow early diastolic velocity (E-wave), E/A ratio, and E/e’ ratio, while the average early diastolic mitral annular tissue velocity (e’) was significantly lower (all P < 0.05). Multivariate analysis identified LAVI and the E/e’ ratio as independent risk factors (OR = 1.154, 95% CI: 1.057– 1.260, P = 0.001; OR = 2.545, 95% CI: 1.344– 4.821, P = 0.004, respectively). The AUC was 0.722 for LAVI and 0.764 for the E/e’ ratio. The combined predictive model incorporating both parameters yielded an AUC of 0.809 (95% CI: 0.726– 0.891), and demonstrated robust internal validation, good calibration, and positive clinical net benefit on DCA. Conclusion: Pre-procedural LAVI and E/e’ ratio are independent predictors of AF recurrence post-RFCA. The combined model demonstrates promising predictive performance, warranting further external validation before clinical application. Keywords: atrial fibrillation, radiofrequency catheter ablation, recurrence, echocardiography, risk factors