Abstract
Arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) cause intensive treatment costs. Left atrial electro-anatomical remodeling measured as low voltage areas (LVA) during catheter ablation indicates advanced disease stage and is associated with poor ablation success. The aim of this study was to analyze the prediction of LVA and arrhythmia recurrences using APPLE, DR-FLASH and MB-LATER scores. APPLE, DR-FLASH scores were calculated at baseline and MB-LATER at 3 months post-ablation in AF patients undergoing first catheter ablation. LVA was determined using high-density maps and defined as <0.5 mV. Early (ERAF, <3 months) and late (LRAF, 3–12 months) were analyzed during follow-up. The study population included 241 patients (age 64 ± 11 years, 59% males, 59% persistent AF, 27% LVA, 27% LRAF). LVA were significantly associated with recurrences (OR 2.081, p = 0.026). While on univariable analysis, all scores were significantly associated with LVA, on multivariable analysis only APPLE (OR 1.789, p < 0.001) and DR-FLASH (OR 2.144, p < 0.001) remained significant predictors. However, MB-LATER (OR 1.445, p = 0.034) and ERAF (OR 5.078, p < 0.001) remained associated with LRAF on the multivariable analysis. These results were validated in a subgroup of 873 patients (age 61 ± 10, 63% males, 39% persistent AF, 34% LRAF, 27% LVA) from The Leipzig Heart Center AF Ablation Registry. All scores were significantly associated with recurrences. However, ERAF was the most powerful predictor for later rhythm outcomes. Summarizing, a clinical score useful for prediction for both LVA and rhythm outcomes in AF patients remains a clinical unmet need.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia, which is associated with an increased risk of dementia, heart failure and thromboembolism, leading to an increased mortality1
We demonstrated that the APPLE score was useful to predict low voltage areas (LVA), too10
The MB-LATER score (one point for Male gender, Bundle branch block or QRS >120 ms, left atrial (LA) diameter ≥47 mm, atrial fibrillation (AF) Type, Early Recurrence 12 months) after catheter ablation11, but its potential to predict the presence of LVA during catheter ablation is unknown
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia, which is associated with an increased risk of dementia, heart failure and thromboembolism, leading to an increased mortality. With extensive AF substrate and higher recurrence rates after catheter ablation of persistent AF6. The DR-FLASH score (based on Diabetes mellitus, Renal dysfunction, persistent AF type, LA diameter >45 mm, Age >65 years, female Sex, and Hypertension) was recently introduced to predict LVA and demonstrated a high predictive ability (AUC = 0.801, p < 0.001). We introduced the APPLE score (one point for Age >65 years, Persistent AF, imPaired eGFR (
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