Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation

Mark J Mulder,Michiel J.B Kemme,Luuk H.G.A Hopman,Elif Kuşgözoğlu,Hatice Gülçiçek,Peter M Van De Ven,Herbert A Hauer,Giovanni J.M Tahapary,Marco J.W Götte,Albert C Van Rossum,Cornelis P Allaart

doi:10.1016/j.ijcard.2021.09.029

Mark J Mulder, Michiel J.B Kemme + Show 9 more

Open Access

https://doi.org/10.1016/j.ijcard.2021.09.029

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Abstract

BackgroundA significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Various risk scores have been described that may predict outcomes after AF ablation. In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. MethodsA total of 482 AF patients (63% paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography (TTE) and either cardiac CT imaging or CMR imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2DS2-VASc, DR-FLASH, HATCH, LAGO and MB-LATER. ResultsMedian follow-up was 16 (12–31) months. AF recurrence after a 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124–360) days. AF recurrence was less frequent in paroxysmal AF patients compared to non-paroxysmal AF patients (34% vs. 54%, p < 0.001). Overall periprocedural complication rate was 6%. All scores, except the HATCH score, demonstrated statistically significant but poor predictive value for recurrent AF after ablation (area under curve [AUC] 0.553–0.669). CHA2DS2-VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). ConclusionsCurrently available risk scores perform poorly in predicting outcomes after AF ablation. These data suggest that the utility of these scores for clinical decision-making is limited.

Highlights

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with an important increase in mortality and morbidity, such as heart failure and stroke [1]
A cohort of 482 patients was included for analysis after exclusion of patients with pre procedural computed tomography (CT)/cardiac magnetic resonance (CMR) imaging of insufficient quality and patients who were lost to follow up before 1 year after ablation procedure
A pre procedural CT was available in 433 patients (90%), whereas a pre procedural MRI was available in the remaining 49 patients (10%)

Summary

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with an important increase in mortality and morbidity, such as heart failure and stroke [1]. Pulmonary vein isolation (PVI) by catheter ablation is a well-established treatment for symptomatic AF, a significant number of patients experience recurrent AF after ablation and complications may occur [1,2]. This study evaluates ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications in an all-comers population undergoing index AF ablation. We aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. Conclusions: Currently available risk scores perform poorly in predicting outcomes after AF ablation. These data suggest that the utility of these scores for clinical decision-making is limited

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