Abstract: Objective To investigate changes in skin sympathetic nerve activity (SKNA) in patients with atrial fibrillation (AF) undergoing radiofrequency catheter ablation (RFCA), and its association with postoperative recurrence.Methods This is a retrospective study. Patients who underwent their first RFCA for AF from January 2021 to October 2022 were included. Based on follow-up outcomes, the patients were divided into two groups: recurrence and non-recurrence. Their SKNA levels before and after surgery were collected to assess the impact of RFCA on SKNA. Logistic regression analysis was conducted to identify predictors of AF recurrence, and the predictive value of SKNA was evaluated using receiver operating characteristic (ROC) curve analysis.Results A total of 272 AF patients were enrolled, with a mean age of (61.59±10.93) years; 68.0% were male and 52.2% had paroxysmal AF. The follow-up period was one year, and the recurrence rate after RFCA was 26.8% (73/272). Postoperative SKNA was significantly lower in the recurrence group than that in the non-recurrence group 557.70 (343.60, 709.35) vs. 877.60 (542.10, 1 514.90), P<0.001. Furthermore, there was no significant difference in SKNA in the recurrence group before and after surgery (P>0.05), whereas SKNA increased significantly after RFCA in the non-recurrence group 877.60(542.10,1 514.90) vs. 497.90 (390.20,769.60), P<0.001. Multivariate logistic regression identified left atrial diameter (OR=1.108, 95%CI:1.043-1.177) and postoperative SKNA (OR=0.332,95%CI:0.209-0.528) as independent predictors of AF recurrence. ROC analysis showed that postoperative SKNA had an area under the ROC curve (AUC) of 0.721 for predicting AF recurrence, with a cutoff value of 764.15 nV, yielding a sensitivity of 78.1% and a specificity of 58.3%.Conclusions SKNA is an independent predictor of AF recurrence after RFCA. Postoperative SKNA shows good predictive value for recurrence in AF patients after RFCA.