Abstract Body (Do not enter title and authors here): Background: Clinical studies on atrial fibrillation (AF) recurrence after catheter ablation in patients diagnosed with patent foramen ovale (PFO) and paroxysmal AF (PAF) are scarce. Here, we aimed to develop a nomogram model utilizing multimodal data for the risk stratification of AF recurrence following catheter ablation in individuals diagnosed with PFO and new-onset PAF.

Methods: Patients with PFO and PAF who underwent catheter ablation at our hospital from January 2018 to June 2020 were consecutively enrolled. The identification of potential risk factors was conducted using the regression method known as least absolute shrinkage and selection operator. Subsequently, multivariate COX regression analysis was conducted to determine the independent risk factors, after which a nomogram scoring system was developed. The nomogram's performance was assessed via various statistical measures, including receiver operating characteristic curve analysis, calibration curve, and decision curve analysis (DCA).

Results: The dataset was partitioned into the development cohort (n=102) and the validation cohort (n=43) using a 7:3 ratio. The constructed nomogram included four clinical variables: age, diabetes mellitus, lipoprotein (a), and right ventricular diameter. The area under the curve values of the development and validation cohorts at 1, 2, and 3 years post-catheter ablation were 0.911, 0.812, and 0.786 and 0.842, 0.761, and 0.785, respectively. Additionally, the nomogram demonstrated a significant correlation between the predicted and actual outcomes in the development and validation cohorts, indicating its excellent calibration. Lastly, the DCA findings suggested that the model had notable clinical applicability in predicting the likelihood of AF recurrence within 1, 2, and 3 years after catheter ablation.

Conclusion: The incorporation of multimodal data in a nomogram visualization tool facilitates the concise representation of multimodal data, thereby enhancing the comprehension of the clinical status of patients with PFO and PAF following catheter ablation and providing accurate risk stratification at 1, 2, and 3 years post-treatment.

Trial registration: This trial was registered in the Chinese Clinical Trial Registry
(ChiCTR2300072320).