Development and Validation of a Novel Prognostic Model Predicting the Atrial Fibrillation Recurrence Risk for Persistent Atrial Fibrillation Patients Treated with Nifekalant During the First Radiofrequency Catheter Ablation

Abstract

Background This study aimed to establish and assess a prediction model for patients with persistent atrial fibrillation (AF) treated with nifekalant during the first radiofrequency catheter ablation (RFCA). Methods In this study, 244 patients with persistent AF from January 17, 2017 to December 14, 2017, formed the derivation cohort, and 205 patients with persistent AF from December 15, 2017 to October 28, 2018, constituted the validation cohort. The least absolute shrinkage and selection operator regression was used for variable screening and the multivariable Cox survival model for nomogram development. The accuracy and discriminative capability of this predictive model were assessed according to discrimination (area under the curve [AUC]) and calibration. Clinical practical value was evaluated using decision curve analysis. Results Body mass index, AF duration, sex, left atrial diameter, and the different responses after nifekalant administration were identified as AF recurrence-associated factors, all of which were selected for the nomogram. In the development and validation cohorts, the AUC for predicting 1-year AF-free survival was 0.863 (95% confidence interval (CI) 0.801–0.926) and 0.855 (95% CI 0.782–0.929), respectively. The calibration curves showed satisfactory agreement between the actual AF-free survival and the nomogram prediction in the derivation and validation cohorts. In both groups, the prognostic score enabled stratifying the patients into different AF recurrence risk groups. Conclusions This predictive nomogram can serve as a quantitative tool for estimating the 1-year AF recurrence risk for patients with persistent AF treated with nifekalant during the first RFCA.

Predictive Value of Machine Learning for Recurrence of Atrial Fibrillation after Catheter Ablation: A Systematic Review and Meta-Analysis

“…Among them, one article was unavailable in full text, 6 articles were excluded for other reasons, and one article was deleted due to duplication of an identical cohort. Finally, 40 studies were included in this systematic review and meta-analysis [ 12 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Fig.…”

“…The majority of catheter ablation procedures were performed using radiofrequency ablation or cryoablation, and the average follow-up time ranged from 4 months to 120 months. Patients from the United States were represented in 6 studies [ 12 , 17 , 18 , 19 , 20 , 21 ], Europe in 11 studies [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], and the Asia-Pacific region in 23 studies [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Regarding the ML algorithms, logistic regression was the most commonly used method for predicting AF recurrence after catheter ablation, accounting for 24 out of 40 studies (60%).…”

Meta‑analysis of the efficacy and safety of nifekalant in the conversion of atrial fibrillation

“…Given the superiority of nifekalant in the treatment of AF, this drug not only compensates for some of the disadvantages of classical drugs, such as propafenone and amiodarone, but also improves the patient's experience of treatment ( 14 ). In addition, to the best of our knowledge, there are limited data on the pharmacological conversion of AF by intravenous nifekalant administration during radiofrequency ablation ( 15 ). The present study aimed to review the available evidence and assess the efficacy and safety of nifekalant in the conversion of AF by performing statistical analysis on conversion indicators.…”

Improved prognostic value of recurrence for atrial fibrillation patients after cryoablation by non-linear survival models

“…Other scholars have used the nomogram method to analyze the postoperative prognosis of patients with AF Zhou et al (2021)[23]. explored the risk factors for recurrence of atrial fibrillation (AF) in patients after radio frequency ablation and constructed a targeted nomogram prediction model (AUC=0.852).Dong et al (2022)[24] used the least absolute shrinkage and selection operator regression for variable screening and a multi-variable Cox survival model for nomogram development, obtaining an AUC of between 0.855 and 0.863 in the development and validation cohorts. Our study combines the nonlinear part of machine learning and the linear part of the Cox model to obtain a nonlinear proportional risk survival model, enabling the construction of the risk score of AF patients to divide them into high-and low-risk groups.…”