Machine learning-based analysis of risk factors for atrial fibrillation recurrence after Cox-Maze IV procedure in patients with atrial fibrillation and chronic valvular disease: A retrospective cohort study with a control group

Jiang, Zenan; Song, Lan; Liang, Chunshui; Zhang, Hao; Tan, Haoyu; Sun, Yaqin; Guo, Ruikang; Li, Liming

doi:10.3389/fcvm.2023.1140670

Cited by 3 publications

(5 citation statements)

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“…Unfortunately, drug therapy generally has serious side effects, and the stable maintenance of SR after catheter ablation often requires multiple ablations, both of which have not significantly improved patients’ left heart function and quality of life ( 13 ). Currently, the radiofrequency-based Cox-Maze IV procedure has replaced the original “cut-and-sew technique” as the main treatment for surgical ablation of AF, and the corresponding surgical ablation devices have also been developed rapidly ( 14 ). After decades of turnover, in the current domestic market the bipolar radiofrequency ablation forceps ( MZ-RFK ) manufactured by Med-Zenith are more frequently used in clinical application.…”

Section: Discussionmentioning

confidence: 99%

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

Zhang,

Hou,

Mei

et al. 2024

Front. Cardiovasc. Med.

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BackgroundCurrently, the bipolar radiofrequency ablation forceps manufactured by AtriCure are the main instrument for surgical ablation in patients with rheumatic heart disease (RHD) concomitant with atrial fibrillation (AF). The bipolar radiofrequency ablation forceps by Med-Zenith has a greater advantage in price compared with AtriCure. However, few studies have been reported on the comparison of their clinical efficacy. The aim of this study is to compare the short-term clinical efficacy of the two ablation forceps for RHD concomitant with AF.MethodsClinical data of 167 patients with RHD concomitant with AF admitted to the Department of Cardiac Major Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, were retrospectively analyzed, and the restoration efficacy of sinus rhythm (SR) and cardiac function after surgery were compared with two ablation forceps.ResultsThe end-systolic diameter of the right atrium and the end-systolic diameter of the left atrium in the patients of both groups at each postoperative time point decreased compared with that of the preoperative period (P < 0.05), and the left ventricular ejection fraction started to improve significantly at 6 months after surgery compared with that of the preoperative period (P < 0.05). There was no difference between the two groups of patients in the comparison of the aforementioned indicators at different points in time (P > 0.05). At 12 months postoperatively, the SR maintenance rate in using the ablation forceps by Med-Zenith (73.3%) was lower than that for AtriCure (86.4%) and the cumulative recurrence rate of AF in using the Med-Zenith ablation forceps was greater than that for AtriCure.ConclusionsThe two bipolar radiofrequency ablation forceps compared in the study are safe and effective in treating patients of RHD concomitant with AF, and the ablation forceps by AtriCure may be more effective in restoring SR in the short term.

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Section: Discussionmentioning

confidence: 99%

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

Zhang,

Hou,

Mei

et al. 2024

Front. Cardiovasc. Med.

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“…It is worth noting that this classification model, with Acc and AUC values of about 80% and 78%, respectively, exhibited comparable or slightly better performance compared to previous works, even when using a more unbiased and robust validation methodology, such as 100 repetitions in a 5 fold cross-validation approach [47] (see Table 3). Although some aspects related to datasets, like the size, heterogeneity, and follow-up period, might impact the classification results of predictive models, it is still possible to highlight that the proposed ECG-based analysis of the f -wave variability over time can provide useful and complementary information for the previously introduced clinical and anatomical predictors of AF recurrence after Cox-Maze surgery [21][22][23][24]. This idea has also been suggested by Kakuta and coworkers [50], who recently proposed a 10-point risk score model for preoperative predictions of Cryo-Maze success in the long term by integrating clinical and anatomical information with an f -wave characteristic measured from the surface ECG.…”

Section: Discussionmentioning

confidence: 99%

“…To shed more light on this aspect, in a recent work by Jiang and colleagues [ 24 ], the authors explored multiple machine learning models, combining 58 clinical variables to predict AF recurrence 5 years after the Cox–Maze procedure and valve surgery. The proposed models exhibited AUC values between 73.20% and 76.80%, revealing that the most significant preoperative features were the AF duration, left ventricular ejection fraction, neutrophil–lymphocyte ratio, left atrial diameter, and heart rate.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Most previous studies dealing with preoperative predictions of Cox–Maze surgery have presented limited outcomes from the point of view of clinical application, emphasizing clinical and anatomical information associated with atrial function [ 21 , 22 , 23 , 24 ]. In particular, Jiang and colleagues [ 24 ] developed multiple machine learning models based on 58 clinical variables, demonstrating that the most significant preoperative features for predicting AF recurrence were the duration of the arrhythmia, left ventricular ejection fraction, left atrial diameter, neutrophil–lymphocyte ratio, and heart rate. Other studies have also extolled the high predictive capacity of some of these metrics, e.g., AF duration and preoperative left atrial diameter, yielding accuracy (Acc) values of about 75% [ 22 ], whereas others yielded much lower Acc values of 55.3 and 68.7%, respectively, and highlighted the performance of other metrics such as the heart rate, with an Acc of 75.8% [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Novel Entropy-Based Metrics for Long-Term Atrial Fibrillation Recurrence Prediction Following Surgical Ablation: Insights from Preoperative Electrocardiographic Analysis

Escribano,

Ródenas,

García

et al. 2023

Entropy

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Atrial fibrillation (AF) is a prevalent cardiac arrhythmia often treated concomitantly with other cardiac interventions through the Cox–Maze procedure. This highly invasive intervention is still linked to a long-term recurrence rate of approximately 35% in permanent AF patients. The aim of this study is to preoperatively predict long-term AF recurrence post-surgery through the analysis of atrial activity (AA) organization from non-invasive electrocardiographic (ECG) recordings. A dataset comprising ECGs from 53 patients with permanent AF who had undergone Cox–Maze concomitant surgery was analyzed. The AA was extracted from the lead V1 of these recordings and then characterized using novel predictors, such as the mean and standard deviation of the relative wavelet energy (RWEm and RWEs) across different scales, and an entropy-based metric that computes the stationary wavelet entropy variability (SWEnV). The individual predictors exhibited limited predictive capabilities to anticipate the outcome of the procedure, with the SWEnV yielding a classification accuracy (Acc) of 68.07%. However, the assessment of the RWEs for the seventh scale (RWEs7), which encompassed frequencies associated with the AA, stood out as the most promising individual predictor, with sensitivity (Se) and specificity (Sp) values of 80.83% and 67.09%, respectively, and an Acc of almost 75%. Diverse multivariate decision tree-based models were constructed for prediction, giving priority to simplicity in the interpretation of the forecasting methodology. In fact, the combination of the SWEnV and RWEs7 consistently outperformed the individual predictors and excelled in predicting post-surgery outcomes one year after the Cox–Maze procedure, with Se, Sp, and Acc values of approximately 80%, thus surpassing the results of previous studies based on anatomical predictors associated with atrial function or clinical data. These findings emphasize the crucial role of preoperative patient-specific ECG signal analysis in tailoring post-surgical care, enhancing clinical decision making, and improving long-term clinical outcomes.

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Predictive value of neutrophil to lymphocyte ratio for clinical outcome in patients with atrial fibrillation: a systematic review and meta-analysis

Peng,

Liu,

Chai

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe association between the Neutrophil-to-Lymphocyte Ratio (NLR) and the prognosis of Atrial Fibrillation (AF) has been extensively studied, yet clinical outcomes have varied. Consequently, this analysis was undertaken to explore the link between NLR and the prognostic markers of AF.MethodsWe conducted an exhaustive search across electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to investigate the correlation between the NLR and indicators of adverse clinical outcomes associated with AF from the database establishment date through March 31, 2024. In this study, the recurrence rate of AF was the primary outcome measure, while the secondary outcome measures were mortality, stroke, and left atrial thrombus. Odds ratio (OR), relative risk (RR), hazard ratio (HR) and standard mean difference (SMD) with a 95% confidence interval (CI) were integrated for assessment, and the stability of prognostic outcomes and publication bias were verified by sensitivity analysis and Egger's test, respectively. Subgroup analyses were performed to pinpoint the sources of heterogeneity.ResultsThis analysis included 20 studies, encompassing a total of 59,256 patients. Our statistical analysis of both categorical and continuous variables revealed that an elevated NLR was significantly associated with increased risks in AF patients for recurrence (categorical variable: OR = 1.39, 95% CI = 1.21–1.60; continuous variable: SMD = 0.49, 95% CI = 0.24–0.74), mortality (categorical variable: OR = 1.87, 95% CI = 1.59–2.20), stroke (categorical variable: OR = 1.56, 95% CI = 1.13–2.17; continuous variable: SMD = 0.77, 95% CI = 0.63–0.91), and left atrial thrombus (categorical variable: OR = 1.87, 95% CI = 1.27–2.75; continuous variable: SMD = 0.59, 95% CI = 0.30–0.89). Subgroup analyses found that high NLR was significantly linked to AF recurrence when the NLR was >3. High NLR was significantly linked to the risk of stroke in AF when the NLR was ≤3.ConclusionsThis study suggested that a high NLR is significantly linked to prognostic risk markers of AF, and NLR may be an effective biomarker for the prognosis of AF in clinical practice.Systematic Review RegistrationPROSPERO (CRD42024530970).

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Machine learning-based analysis of risk factors for atrial fibrillation recurrence after Cox-Maze IV procedure in patients with atrial fibrillation and chronic valvular disease: A retrospective cohort study with a control group

Cited by 3 publications

References 61 publications

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

Novel Entropy-Based Metrics for Long-Term Atrial Fibrillation Recurrence Prediction Following Surgical Ablation: Insights from Preoperative Electrocardiographic Analysis

Predictive value of neutrophil to lymphocyte ratio for clinical outcome in patients with atrial fibrillation: a systematic review and meta-analysis

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