Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation. (1st December 2021)

• Record Type: Journal Article
• Authors: Mulder, Mark J.; Kemme, Michiel J.B.; Hopman, Luuk H.G.A.; Kuşgözoğlu, Elif; Gülçiçek, Hatice; van de Ven, Peter M.; Hauer, Herbert A.; Tahapary, Giovanni J.M.; Götte, Marco J.W.; van Rossum, Albert C.; Allaart, Cornelis P.
• Is Part Of: International journal of cardiology. Volume 344(2021)
• Page Start: 103
• Page End: 110
• Publication Date: 2021-12-01
• Subjects: Atrial fibrillation -- Catheter ablation -- Pulmonary vein isolation -- Risk score; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.09.029
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Various risk scores have been described that may predict outcomes after AF ablation. 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 (63% paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography (TTE) and either cardiac CT imaging or CMR imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2 DS2 -VASc, DR-FLASH, HATCH, LAGO and MB-LATER. Results: Median follow-up was 16 (12–31) months. AF recurrence after a 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124–360) days. AF recurrence was less frequent in paroxysmal AF patients compared to non-paroxysmal AF patients (34% vs. 54%, p < 0.001). Overall periprocedural complication rate was 6%. All scores, except the HATCH score, demonstrated statistically significant but poor predictive value for recurrent AF after ablation (area under curve [AUC] 0.553–0.669). CHA2 DS2 -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). Conclusions: Currently available risk scores perform poorly in predicting outcomes after AF ablation. These data suggest that the utility of these scores for clinical decision-making is limited. Highlights: Current risk scores have poor predictive value for outcomes of AF ablation. Utility of current scores for clinical decision-making in AF patients is limited. Establishing novel risk factors may improve prediction of AF ablation outcomes. Efforts should be undertaken to improve reproducibility of achieving PVI.