Development and validation of clinical prediction models for cardiorespiratory fitness in atrial fibrillation patients following radiofrequency catheter ablation.

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Zhao, Guiling;  Department of Cardiology, Xinhua Hospital , Shanghai, China.
Sun, Jian;Che, Qianji;Xu, Wenqing; et al

Frontiers in cardiovascular medicine,2025 Aug 29

  • Background: Assessment of cardiorespiratory fitness (CRF) is imperative in patients with atrial fibrillation (AF) who have had radiofrequency catheter ablation (RFCA). This study aimed to develop and validate CRF prediction models in this population.
  • Methods: 141 AF patients with RFCA were recruited. The cardiopulmonary exercise test was used to assess CRF with VO 2peak and METs max . Multidimensional predictors (demographics, serum biomarkers, cardiovascular parameters, and motor function parameters) were analyzed through Spearman correlation analysis and stepwise multivariate linear regression analysis. The internal validity of the prediction equation was tested by paired Student’s t -test, Pearson correlation analysis and Bland-Altman analysis.
  • Results: Sex, BMI, ln NT-proBNP, glucose (GLU), 6-minute walking distance (6MWD), and systolic blood pressure (SBP) were found to be significantly associated with CRF in this population. Multivariate linear regression generated the equations: VO 2peak = 35.080 – 0.286 * BMI – 1.927 * Sex – 1.090 * ln NT-proBNP + 0.011 * 6MWD – 0.039 * SBP – 0.512 * GLU, and METs max = 9.646 – 0.447 * Sex – 0.260 * ln NT-proBNP – 0.140 * GLU – 0.078 * BMI – 0.016 * SBP + 0.004 * 6MWD, (VO 2peak : adjusted R 2 = 0.506, and METs max : adjusted R 2 = 0.469, both P < 0.01). Pearson correlations between the predicted values and the measured values showed good validity (VO 2peak : r = 0.616, and METs max : r = 0.581, both P < 0.01). The Bland-Altman analysis showed that the predicted VO 2peak values were slightly lower than the measured values (mean difference = -0.13; 95% limits of agreement: -5.20 to 4.93), while the predicted METs max values were in close agreement with the measured values (mean difference = -0.00; 95% limits of agreement: -1.59 to 1.59).
  • Conclusion: Sex, BMI, NT-proBNP, glucose, 6MWD, and SBP are robust predictors of VO 2peak and METs max in AF population after RFCA. This study generates and internal validates the first multivariable CRF prediction models with easy-to use clinical paraments in AF patients after RFCA, thereby providing safe and effective alternatives to conventional CPX, which may help to optimize personalized patient management.