A NEW five-variable nomogram has shown promise in predicting atrial fibrillation (AF) recurrence following cryoballoon ablation, potentially helping clinicians tailor post-procedure care and improve patient outcomes.
Atrial Fibrillation Recurrence Risk Model
Researchers developed and internally validated a predictive model that integrates clinical, electrocardiographic, and echocardiographic features. The study included 757 patients undergoing first-time cryoballoon ablation between 2017 and 2023. Participants were randomly divided into training (70%) and validation (30%) cohorts to ensure robust assessment.
The five independent predictors identified were female sex, persistent AF, prolonged PR interval, enlarged left atrial dimension (LAD), and reduced left atrial appendage flow velocity (LAAFV). Using these variables, a multivariable Cox proportional hazards model generated a nomogram to estimate individual risk of AF recurrence at 12 and 24 months.
Strong Performance Compared With Existing Tools
When benchmarked against widely used risk scores, including APPLE, SUCCESS, PAT2C2H, HATCH, BASE-AF2, and CHA₂DS₂-VASc, the nomogram consistently demonstrated superior predictive performance. Area under the curve (AUC) values were 0.81 and 0.83 in the training set and 0.82 and 0.80 in the validation set at 12 and 24 months, respectively. Risk stratification effectively divided patients into low-, intermediate-, and high-risk groups, with 24-month recurrence-free survival rates of approximately 80%, 45%, and 20%.
Clinical Implications
By combining structural and functional atrial measurements with clinical features, this model offers a more precise tool to guide post-ablation management, which could lead to closer monitoring or adjunctive therapy in higher-risk patients.
Cryoballoon ablation remains a widely adopted intervention for AF, yet recurrence after the procedure is common, sometimes complicating long-term management. Existing prediction models often omit detailed atrial measurements, limiting their ability to guide individualized care. This new nomogram addresses those gaps, providing clinicians with a practical and evidence-based tool to identify patients most likely to experience recurrence.
While the findings are encouraging, the researchers emphasise that prospective multicentre external validation is required before the nomogram can be adopted in routine clinical practice.
Reference
J Qiqiang et al. Five-variable nomogram including PR interval and left atrial appendage flow velocity predicts atrial fibrillation recurrence after cryoballoon ablation. Sci Rep. 2026; DOI:10.1038/s41598-026-35653-9.
