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

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.