Abstract: Objective: To identify risk factors for recurrence after the first-time radiofrequency ablation(RFA) procedure in patients with atrial fibrillation, and to construct and validate a nomogram prediction model. Methods: Preoperative clinical data were collected from 230 patients who underwent their first-time RFA for atrial fibrillation at the First Affiliated Hospital of Guangxi Medical University between June 2020 and June 2023. Patients were categorized into a recurrence group and a non-recurrence group depending on their postoperative follow-up outcomes. The least absolute shrinkage and selection operator(LASSO) method was used for preliminary variable screening to establish the nomogram. Patients were randomly allocated to training and validation cohorts. Multivariate logistic regression analysis was performed on the training set to ultimately determine the key variables and construct the nomogram model. Finally, the model's discrimination, calibration, and clinical usefulness were validated using the receiver operating characteristic(ROC) curves, calibration plots, and decision curve analysis. Results: Statistically significant differences were observed between the non-recurrence and recurrence groups in the monocyte-to-high-density lipoprotein cholesterol ratio(MHR) 0.46(0.37-0.61) vs. 0.63(0.49-0.88), P<0.001, N-terminal pro-B-type natriuretic peptide(NT-proBNP) 270.50(83.91-786.32) vs. 916.55(488.15-1,828.25), P<0.001, and left atrial diameter(LAD) 38.00(33.00-44.00) vs. 46.00(40.75-49.00), P<0.001. Multivariate logistic regression analysis identified MHR(OR=22.530, 95% CI: 3.88-130.87, P<0.001), NT-proBNP(OR=1.00, 95% CI: 1.00-1.01, P=0.003), and LAD(OR=1.080, 95% CI: 1.01-1.15, P=0.023) as significant independent factors for atrial fibrillation recurrence after the first-time RFA procedure. ROC curves, calibration curves, and decision curve analysis demonstrated that the nomogram prediction model based on MHR, NT-proBNP, and LAD exhibited good discriminative ability, calibration, and clinical utility in assessing recurrence risk. Conclusion: MHR, NT-proBNP, and LAD are independent risk factors for postoperative atrial fibrillation recurrence. The nomogram model constructed based on these factors demonstrates high accuracy, reliability, and clinical application value in predicting recurrence risk, providing a predictive tool for identifying patients at high risk of recurrence after atrial fibrillation ablation.