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已发表论文
非瓣膜性心房颤动消融术后患者复发预测列线图的验证
Authors Yu Y, Chen JL, Li GY, Huang SS, Wang T, Li XK, Li YG
Received 30 July 2025
Accepted for publication 6 November 2025
Published 20 November 2025 Volume 2025:20 Pages 2091—2104
DOI https://doi.org/10.2147/CIA.S557166
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Maddalena Illario
Yi Yu,1 Jin-Lan Chen,2 Guang-Yin Li,2 Shen-Shen Huang,2 Ting Wang,3 Xiao-Kai Li,2 Yi-Gang Li3
1Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Medical Imaging Technology, Shanghai University of Sport, Shanghai, People’s Republic of China; 3Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai JiaoTong University, Shanghai, People’s Republic of China
Correspondence: Yi Yu, Email yuyichesthospital@163.com Yi-Gang Li, Email liyigang@xinhuamed.com.cn
Purpose: To utilize the developed nomogram for evaluating the risk of recurrence in non-valvular atrial fibrillation (NVAF) patients after radiofrequency catheter ablation (RFCA) and compare the model’s performance with the APPLE, ATLAS, and Antwerp scores.
Patients and Methods: 242 patients with NVAF requiring RFCA were enrolled. These patients were randomly divided into a training cohort (n=169) and a validation cohort (n=73) according to 7:3. A nomogram was developed based on LAVI, RAVI, SII, NYHA classification, CHA2DS2-VASc score to estimate the risk of AF recurrence after RFCA. The APPLE, ATLAS, and Antwerp scores were calculated using the “pROC” package in R software. The AUC value of the nomogram compared with each of the three scores was evaluated using the DeLong test. The integrated discrimination improvement and net reclassification index were calculated to compare the predictive performance of the nomogram against the scores in R software.
Results: The nomogram achieved significantly higher values with an AUC of 0.837 (95% CI: 0.774– 0.899) in the training cohort and 0.895 (95% CI: 0.823– 0.968) in the validation cohort (all P < 0.05) than the three scores. It also achieved better positive and negative predictive values, indicating enhanced discriminatory power. By integrating multidimensional parameters and optimizing risk stratification, it significantly reduced misjudgment rates. Furthermore, the model demonstrated a more balanced sensitivity-specificity profile and greater predictive stability than single-dimensional scores. It also provides more robust clinical decision support for predicting post-RFCA recurrence across diverse datasets.
Conclusion: The APPLE, ATLAS, and Antwerp scores all demonstrated effectiveness in predicting AF recurrence after RFCA in patients with NVAF. Among these established scoring systems, the APPLE score showed better performance compared to the other two. More importantly, our newly developed nomogram exhibited superior performance compared to all three existing scores, demonstrating a marked improvement in predicting the risk of AF recurrence. While our model represents a promising tool, it is still in the preliminary stage and requires further validation in larger, multi-center, prospective cohorts to confirm its generalizability.
Keywords: nomogram, recurrence risk scores, validation, non-valvular atrial fibrillation, radiofrequency catheter ablation
1Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Medical Imaging Technology, Shanghai University of Sport, Shanghai, People’s Republic of China; 3Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai JiaoTong University, Shanghai, People’s Republic of China
Correspondence: Yi Yu, Email yuyichesthospital@163.com Yi-Gang Li, Email liyigang@xinhuamed.com.cn
Purpose: To utilize the developed nomogram for evaluating the risk of recurrence in non-valvular atrial fibrillation (NVAF) patients after radiofrequency catheter ablation (RFCA) and compare the model’s performance with the APPLE, ATLAS, and Antwerp scores.
Patients and Methods: 242 patients with NVAF requiring RFCA were enrolled. These patients were randomly divided into a training cohort (n=169) and a validation cohort (n=73) according to 7:3. A nomogram was developed based on LAVI, RAVI, SII, NYHA classification, CHA2DS2-VASc score to estimate the risk of AF recurrence after RFCA. The APPLE, ATLAS, and Antwerp scores were calculated using the “pROC” package in R software. The AUC value of the nomogram compared with each of the three scores was evaluated using the DeLong test. The integrated discrimination improvement and net reclassification index were calculated to compare the predictive performance of the nomogram against the scores in R software.
Results: The nomogram achieved significantly higher values with an AUC of 0.837 (95% CI: 0.774– 0.899) in the training cohort and 0.895 (95% CI: 0.823– 0.968) in the validation cohort (all P < 0.05) than the three scores. It also achieved better positive and negative predictive values, indicating enhanced discriminatory power. By integrating multidimensional parameters and optimizing risk stratification, it significantly reduced misjudgment rates. Furthermore, the model demonstrated a more balanced sensitivity-specificity profile and greater predictive stability than single-dimensional scores. It also provides more robust clinical decision support for predicting post-RFCA recurrence across diverse datasets.
Conclusion: The APPLE, ATLAS, and Antwerp scores all demonstrated effectiveness in predicting AF recurrence after RFCA in patients with NVAF. Among these established scoring systems, the APPLE score showed better performance compared to the other two. More importantly, our newly developed nomogram exhibited superior performance compared to all three existing scores, demonstrating a marked improvement in predicting the risk of AF recurrence. While our model represents a promising tool, it is still in the preliminary stage and requires further validation in larger, multi-center, prospective cohorts to confirm its generalizability.
Keywords: nomogram, recurrence risk scores, validation, non-valvular atrial fibrillation, radiofrequency catheter ablation