A Nomogram utilizing ECG P-wave parameters to predict recurrence risk following catheter ablation in paroxysmal atrial fibrillation

Abstract

Objective: The objective of this study is to assess the predictive utility of perioperative P-wave parameters in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation, and to develop a predictive model using these parameters.

Methods: A total of 213 patients with PAF undergoing catheter ablation were retrospectively analyzed. P-wave parameters were measured within 3 days preoperatively and on the day postoperatively to determine their predictive significance for postoperative PAF recurrence.

Results: Post-ablation, PAF did not recur in 168 patients, while 45 experienced recurrence. Significant differences were observed in preoperative P-wave parameters as Maximum P Wave Duration(Pmax), absolute value of P Wave Terminal Force of V1 (PtfV1) and P Wave Dispersion(Pd), postoperative P-wave parameters as P Wave Duration (PWD_{II, III, aVF}), Pmax, P Wave Area(P-area), absolute value of PtfV1 and Pd, and changes in perioperative P-wave parameters (Delta-Pmax, Delta-PtfV1 absolute value, Delta-Pd, Delta-PWD_{II, III, aVF}). Univariate logistic regression, receiver operating characteristic (ROC) curve analysis, and hazard ratio assessment identified predictive indicators for postoperative recurrence, including Pmax, PtfV1 absolute value, Pd, post-P area, post-PWD_{II, III, aVF} and Delta-pwd_{II, III, aVF}). A personalized nomogram model based on these P-wave parameters was developed. Calibration curve assessment demonstrated that the predictive performance of the nomogram for PAF recurrence following catheter ablation closely matched actual observed outcomes. ROC curve analysis indicated a sensitivity of 89.3% for the model, and decision curve analysis confirmed its significantly favorable predictive use and clinical benefits.

Conclusions: P-wave parameters like PWD_Ш, PWDaVF, Pmax, Pd, and PtfV1 serve as predictors of PAF recurrence following catheter ablation. The nomogram model constructed using these P-wave parameters demonstrates robust predictive performance.

Keywords: Catheter ablation; Electronic cardiogram; Nomogram model; P-wave parameters; Paroxysmal atrial fibrillation; Recurrent atrial fibrillation.

Fig. 1

Preoperative and postoperative changes of parameters: A comparison between the PWD values of the ECG for the 12 leads prior to and following catheter ablation. B Comparing the 12-lead ECG’s PWA values prior to and following catheter ablation. C Variations in Pmax value during and after surgery. D P-area value changes prior to and following surgery. E variations in Pd values prior to and following surgery. F preoperative and postoperative P-index value changes. G preoperative and postoperative PtfV1 absolute value changes. H preoperative, and postoperative PtfV1 value changes. *P < 0.05

Fig. 2

ROC curve analysis of post-PWD and Delta-PWD following catheter ablation. (A) post-PWDII ROC curve. (B) post-PWDIII ROC curve. (C) post-PWDaVF ROC curve. (D) Delta-PWDII ROC curve; (E) Delta-PWDIII ROC curve; (F) Delta-PWDaVF ROC curve. (G) ROC curve analysis of pre-Pmax. (H) ROC curve of post-Pmax. (I) ROC curve of Delta-Pmax. (J) ROC curve analysis of pre-Pd. K ROC curve analysis of post-Pd. L ROC curve analysis of Delta-Pd. M ROC curve analysis of the absolute value of pre-PtfV1. N ROC curve analysis of the absolute value of post-PtfV1. O ROC curve analysis of the absolute value of Delta-PtfV1. P The post-P-area area under the ROC curve for atrial fibrillation ablation recurrence prediction

Fig. 3

Recurrence risk ratio following atrial fibrillation as indicated by ECG P wave parameters

Fig. 4

ECG P wave parameters used to establish the nomogram model

Fig. 5

ECG P wave parameters predicted and assessed using a nomogram. A Calibration curve. B ROC curve. C DCA curve