CHA2DS2VASc score as a predictor of ablation success defined by continuous long-term monitoring.

Abstract

There are few reliable risk stratification tools for successful atrial fibrillation catheter ablation (AFCA) and most prior studies have used short-term external monitors to define success. CHA2DS2VASc score may be useful in predicting AF recurrence. We investigated whether CHA2DS2VASc score correlates with AFCA success as measured by continuous monitoring via cardiac implantable electronic devices (CIEDs). Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink™ database, we identified patients who underwent a 1st AFCA procedure following CIED implantation. Success was defined as absence of ≥ 1h of AF following a 3-month blanking period. A total of 632 patients (age 67 ± 9.1years, 73.3% male, CHA2DS2VASc 3.6 ± 1.8, 36.9% paroxysmal AF) were analyzed and included 35.1% insertable cardiac monitor, 28.8% PPM, 21.4% ICD, 13.6% CRT-D, and 1.1% CRT-P. Success at 24months post blanking period was 40.3% (95% CI 32.6-49.7%), 36.2% (95% CI 26.9-45.4%), and 21.8% (95% CI 14.6-32.5%) for CHA2DS2VASc subgroups of 0-2, 3-4, and ≥ 5, respectively. Median daily burden of AF was reduced to zero regardless of CHA2DS2VASc score, but there were significant differences in survival free from any AF ≥ 1h between the three CHA2DS2VASc subgroups (p = 0.013). Patients with a score ≥ 5 had a HR of 1.29 (95% CI 1.00-1.67) for AF recurrence compared to patients with a score of 0-2, with similar results after controlling for AF type. In real-world patients with continuous monitoring undergoing AFCA, only CHA2DS2VASc scores ≥ 5 predicted higher AF recurrence.