Abstract
New-onset atrial fibrillation (NeAF) is common after successful ablation of cavotricuspid isthmus-dependent counterclockwise atrial flutter (CCW-AFL). This study aimed to investigate a simple predictive model of NeAF after CCW-AFL ablation. From January 2013 to December 2017, consecutive patients receiving CCW-AFL ablation without previous atrial fibrillation were enrolled from three Chinese centers. Clinical, echocardiographic, and electrocardiographic data were collected and followed regularly. Patients from two centers and another center were assigned into the derivation cohort and validation cohort, respectively. In the derivation cohort, logistic regression was performed to evaluate the ability of the above parameters to discriminate those with and without NeAF. A score system was developed and then validated in the validation cohort. Two hundred seventy-one patients (mean 59.7±13.6 age; 205 male) were analyzed. During follow-up (73.0±6.5 months), 107 patients (39.5%) had NeAF. 190 (76 with NeAF, 40.0%) and 81 patients (31 with NeAF, 38.3%) were detected in the derivation and validation cohorts, respectively. Hypertension, age ≥70 years, left atrial diameter ≥42 mm, duration of P wave in lead II ≥120 ms and the negative component of flutter wave in lead II ≥120 ms were selected as the final predictive parameters. A weighted score based on these variables was used to develop the HAD-AF score ranging from 0 to 9. In the derivation cohort, area under the receiver operating characteristic curve (AUC) of HAD-AF score was 0.938 (95% CI 0.902-0.974), superior to those of currently used CHA2DS2-VASC (0.679, 95% CI 0.600-0.757) and HATCH scores (0.651, 95% CI 0.571-0.730) (P<0.001). Performance maintained in the independent validation cohort (AUC, 0.912; 95% CI 0.846-0.978). 39.5% of patients developed NeAF in 6 years after CCW-AFL ablation. HAD-AF score, based on easily obtained pre-ablation parameters, can reliably identify patients likely to develop NeAF after CCW-AFL ablation.
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