Development and validation of a risk score for predicting atrial fibrillation recurrence after a first catheter ablation procedure – ATLAS score. Issue Volume 20:Issue FI 3(2018) (18th August 2017)

• Record Type: Journal Article
• Authors: Mesquita, João; Ferreira, António Miguel; Cavaco, Diogo; Moscoso Costa, Francisco; Carmo, Pedro; Marques, Hugo; Morgado, Francisco; Mendes, Miguel; Adragão, Pedro
• Is Part Of: Europace. Volume 20:Issue FI 3(2018)
• Page Start: f428
• Page End: f435
• Publication Date: 2017-08-18
• Subjects: Atrial fibrillation -- Atrial fibrillation recurrence -- Pulmonary vein isolation -- Radiofrequency catheter ablation -- Prognosis -- Risk score; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/eux265
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Several predictors of relapse after catheter ablation of atrial fibrillation (AF) have been established, but assessing each patient's individual risk remains challenging. Our aim was to develop and validate a score to estimate the risk of AF recurrence after the first radiofrequency pulmonary vein isolation (PVI) procedure. Methods and results: Independent predictors of AF relapse were identified retrospectively in a two-centre registry of 1934 patients who underwent a first PVI procedure. Using the Cox regression hazard ratios of designated variables, a risk score was developed in a random sample of 50% of the patients (development cohort) and validated in the remaining (validation cohort) half. The accuracy and discriminative power of the predictive model were assessed in both subgroups. During a follow-up of 4.2 ± 2.7 years, 522 patients (27%) relapsed. Five independent predictors of AF recurrence were identified and included in the score: age >60 years (1 point), female sex (4 points), non-paroxysmal AF (2 points), current smoking (7 points) and indexed left atrial volume (1 point for each 10 mL/m 2 ). The score showed good discriminative power (censored c-statistic of 0.75 in both cohorts). In the development group, AF relapse rates were 8, 11, and 17%/year for low (<6 points), intermediate (6–10 points), and high-risk patients (>10 points), respectively ( P < 0.001). In the validation group, AF recurrence rates were 8, 11, and 18%/year, respectively ( P < 0.001). Conclusion: A simple risk score to estimate the rate of AF recurrence after ablation was developed and validated. An external assessment of its usefulness as a patient selection tool seems warranted.