Abstract
The prediction of arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. The aim of current analysis was to investigate the time-dependent prediction of arrhythmia recurrences after AF catheter ablation during long-term follow-up. The study included 879 patients (61 ± 10 years; 64% males; 39% persistent AF) undergoing first AF catheter ablation. Rhythm outcomes were documented using 7-days Holter monitoring. The APPLE score (Age, Persistent AF, imPaired eGFR, Left atrium (LA), EF) was calculated at baseline, while MB-LATER score (Male gender, Bundle branch block, LA, AF Type, Early Recurrences) 3 months after ablation. The median follow-up time was 37 months [95%CI 35;39]. ERAF and LRAF occurred in 45% and 64%, respectively. On multivariable analysis, ERAF (HR 2.095, 95%CI 1.762–2.490, p < 0.001) was strongly associated with LRAF. The APPLE (HR 1.385, 95%CI 1.276–1.505, p < 0.001) and MB-LATER (HR 1.326, 95%CI 1.239–1.419, p < 0.001) scores significantly predicted LRAF during follow-up. On the ROC analysis, APPLE (AUC 0.640, 95%CI 0.602–0.677, p < 0.001) and MB-LATER (AUC 0.654, 95%CI 0.616–0.691, p < 0.001) demonstrated moderate prediction. Summarizing, ERAF was the strongest predictor for LRAF in time-dependent manner. The APPLE and MB-LATER scores demonstrated moderate prediction of arrhythmia recurrences during long term follow-up.
Highlights
Catheter ablation targeting the pulmonary veins still remains the most important therapeutic strategy in atrial fibrillation (AF) treatment with continuous escalation of its popularity since the late 1990s1,2
ERAF and LRAF occurred in 45% and 64%, respectively
The rate of arrhythmia-free survival after catheter ablation depends on the follow-up length and the scores strata
Summary
Catheter ablation targeting the pulmonary veins still remains the most important therapeutic strategy in atrial fibrillation (AF) treatment with continuous escalation of its popularity since the late 1990s1,2. Recurrences lead to repeated ablation procedures and higher hospitalization rates and treatment costs[5]. All this explains a considerable clinical interest to predict the risk for recurrences already before invasive procedure with the goal to shape personalized strategies in AF patients. The APPLE score was originally developed to predict AF recurrences within the first year after catheter ablation[14]. The MB-LATER score has been introduced to predict very late arrhythmia recurrences in arrhythmia-free patients within first 12 months after ablation[15]. The time-dependent prediction of arrhythmia recurrences during very long follow-up period using clinical variables, in addition to APPLE and MB-LATER scores have not been studied and was the aim of current analysis
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