Objective To explore the morphological characteristics of electrocardiographic scatter plots, waterfall plots and electrocardiographic parameters, and their clinical significance in patients with atrial fibrillation after radiofrequency ablation.

Methods A total of 156 atrial fibrillation patients who received radiofrequency ablation treatment were retrospectively selected as the study subjects and followed up for 12 months postoperatively. According to the results of dynamic electrocardiogram and remote electrocardiographic monitoring during the follow-up period, the patients were divided into sinus rhythm maintenance group (101 cases) and atrial fibrillation recurrence group (55 cases). Baseline data, electrocardiographic morphological characteristics (Lorenz scatter plot morphology, waterfall plot band distribution), and electrocardiographic parameters average ventricular rate, standard deviation of normal-to-normal intervals (SDNN), number of 24-hour atrial premature beats, waterfall plot dispersion, left atrial diameter, etc. were collected from all patients. Univariate and multivariate logistic regression analyses were used to screen for factors influencing atrial fibrillation recurrence. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive efficacy of electrocardiographic morphological characteristics and electrocardiographic parameters for postoperative atrial fibrillation recurrence.

Results The proportion of residual sectors in the Lorenz scatter plot was higher in the atrial fibrillation recurrence group than that in the sinus rhythm maintenance group, with a statistically significant difference (P < 0.05). There were statistically significant differences in SDNN, waterfall plot dispersion, and left atrial diameter between the two groups (P < 0.001). Multivariate logistic regression analysis showed that residual sectors (OR=1.950, 95%CI, 1.210 to 3.121), waterfall plot dispersion>0.3 (OR=1.692, 95%CI, 1.182 to 2.424), left atrial diameter>40 mm (OR=2.061, 95%CI, 1.120 to 3.795), and SDNN < 100.15 ms (OR=1.943, 95%CI, 1.256 to 3.011) were independent risk factors for atrial fibrillation recurrence (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) for the combined prediction of atrial fibrillation recurrence by residual sectors, waterfall plot dispersion, left atrial diameter, and SDNN was 0.909, which was greater than the AUC for each indicator alone, with a statistically significant difference (P < 0.001).

Conclusion After radiofrequency ablation in atrial fibrillation patients, the "residual sector" characteristic of the electrocardiographic scatterplot, waterfall plot dispersion, left atrial diameter, and SDNN are all factors influencing atrial fibrillation recurrence. The combined predictive efficacy of these four factors is superior to that of individual prediction, providing a more accurate postoperative risk stratification tool for clinical practice.