Predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation. (24th May 2021)

• Record Type: Journal Article
• Authors: Mulder, MJ; Kemme, MJB; Hopman, LHGA; Kusgozoglu, E; Gulcicek, H; Van De Ven, PM; Hauer, HA; Tahapary, GJM; Van Rossum, AC; Allaart, CP
• Is Part Of: Europace. Volume 23:Supplement 3(2021)
• Publication Date: 2021-05-24
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euab116.231
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Background/Introduction: A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Predicting who will or will not benefit from AF ablation is challenging. Although various risk scores have been designed to predict outcomes after AF ablation, comparative data are sparse and external risk score validation is often lacking. Purpose: 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. Methods: A total of 482 AF patients (37% non-paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (RF-PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography and either cardiac computed tomography imaging or cardiac magnetic resonance 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. The predictive performance of the risk scores for AF recurrence and complications were assessed separately by receiver operating characteristic (ROC) curves. Results: Median follow-up was 16 (12-31) months. AF recurrence after the 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days after ablation. Overall procedural adverse event rate was 6%. The HATCH score was the only score without predictive value for recurrent AF after ablation (area under curve [AUC] 0.545). All other investigated scores demonstrated statistically significant but poor predictive value for recurrent AF after ablation (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). ROC curve analyses of the studied risk scores for the prediction of AF recurrence and complications are shown in Figure. Conclusion: Currently available risk scores perform poorly in predicting outcomes after RF-PVI. These data suggest that the utility of these scores for clinical decision-making is limited.