Combined F-wave and AF Duration Predict Post-Ablation Recurrence in Persistent AF: Dual-Center Study: Combined...

Predicting recurrence after radiofrequency catheter ablation (RFCA) in persistent atrial fibrillation (PeAF) remains challenging. This study evaluated the predictive value of F-wave amplitude (FWA), F-wave duration (FWD) in inferior ECG leads (II, III, aVF), and AF duration for post-ablation recurrence.

In this dual-center retrospective study, 763 persistent atrial fibrillation (PeAF) patients undergoing first RFCA (2017-2022) were analyzed. Pre-procedural FWA and FWD were measured across 12-lead ECGs using MATLAB. Clinical data and 12-month follow-up outcomes were collected. Independent predictors were identified via binary logistic regression, and a gradient boosting machine (GBM) model was developed. Model performance was assessed using ROC curves, calibration plots, and decision curve analysis (DCA), with internal (random split) and external (between-center) validation.

At 12 months, 198 patients (26%) experienced recurrence. Recurrence patients exhibited significantly lower inferior lead FWA (0.108 [0.076-0.157] vs. 0.126 [0.087-0.173] mV, p = 0.003), narrower FWD (54.96 [40.26-71.31] vs. 61.46 [42.7-76] ms, p = 0.038), and longer AF duration (13.8 [4-38] vs. 6.5 [3-21] months, p < 0.001). Multivariate analysis identified inferior lead FWA (OR = 0.788, 95%CI 0.662-0.937, p = 0.007) and AF duration (OR = 1.014, 95%CI 1.007-1.021, p < 0.001) as independent predictors. The model combining AF duration and FWA achieved an AUC of 0.692 (95%CI 0.648-0.737), improving to 0.746 (0.701-0.787) with FWD inclusion. Validation demonstrated stable discrimination (internal AUC = 0.722, 95%CI 0.680-0.762; external AUC = 0.703, 0.659-0.747).

Inferior lead FWA and AF duration are independent predictors of post-RFCA recurrence in persistent AF. The combined model integrating these parameters with FWD shows robust discriminative ability and clinical utility, supporting personalized treatment strategies.