Repeat Catheter Ablation of Long-standing Persistent Atrial Fibrillation in Patients with a Total Atrial Fibrillation Duration of More Than 2 Years: Effects of the CHA2DS2-VASc Score and Estimated Glomerular Filtration Rate on the Outcomes

Pulmonary Vein Isolation Outcome Degree Is a New Score for Efficacy of Atrial Fibrillation Catheter Ablation

This study introduces the pulmonary vein isolation outcome degree (PVIOD) as a new semiquantitative measure for the efficacy of atrial fibrillation (AF) catheter ablation and reports the determination of predictors associated with PVIOD. The median follow-up periods of 117 patients after the first and last ablation were, respectively, 82 (IQR 15) and 72 (IQR 30) months. PVIOD 1 included 32.5% of patients, those with successful single pulmonary vein isolation (PVI); PVIOD 2 included 29.1% of subjects, those with success after multiple procedures; PVIOD 3 comprised 14.5% of patients, those with clinical success; and PVIOD 4 included 23.9% of cases, those with procedural and clinical failure. In the multivariate ordinal logistic regression analysis, PVIOD 1-4 were independently associated with longstanding persistent AF with paroxysmal AF as the referent category (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1-10.7 (p = 0.031)), left atrial (LA) diameter (OR, 1.2; 95% CI, 1.1-1.3 (p = 0.001)) and left ventricular ejection fraction (LVEF) (OR, 0.9; 95% CI, 0.86-1.0 (p = 0.038)). LA size > 41 mm, LVEF ≤ 50% and longstanding persistent AF are strong predictors of AF recurrence. PVIOD 1-4 offer the most exact long-term prognosis of PVI. The purpose of the present article is to expand the quantitative measure of procedural success in the medical and biological fields.

CHA2DS2-VASc Score as a Predictor of New-Onset Atrial Fibrillation After Catheter Ablation of Typical Atrial Flutter

Purpose

Cavotricuspid isthmus (CTI) ablation is an effective procedure for typical atrial flutter (AFL), but patients remain at an elevated risk for developing new atrial fibrillation (AF). Currently, there are limited data on the utility of CHA₂DS₂-VASc score to predict new-onset AF after typical AFL ablation. In this study, we assessed whether the CHA₂DS₂-VASc score is a useful predictor of new-onset AF after CTI ablation in typical AFL patients without a prior history of AF.

Methods

This was a retrospective study of 103 typical AFL patients with no prior history of AF, who underwent successful CTI ablation. The endpoint was occurrence of new-onset AF during follow-up.

Results

During a mean follow-up period of 24.6 ± 16.9 months, at least one episode of AF occurred in 33 (32%) patients. Multivariate Cox regression analysis revealed that CHA₂DS₂-VASc score (hazard ratio = 1.736; 95% confidence interval = 1.370–2.201; P < 0.001) was significantly associated with postablation new-onset AF (area under the curve = 0.797). A cutoff value of three stratified these patients into two groups with different incidences of postablation new-onset AF (67.9 vs. 18.7%, P < 0.001).

Conclusion

The CHA₂DS₂-VASc score is a useful tool for the prediction of new-onset AF after ablation of typical AFL. Patients with CHA₂DS₂-VASc score ≥3 are more likely to develop new-onset AF and should be monitored more closely.

The APPLE Score - A Novel Score for the Prediction of Rhythm Outcomes after Repeat Catheter Ablation of Atrial Fibrillation

Background

Arrhythmia recurrences after catheter ablation occur in up to 50% within one year but their prediction remains challenging. Recently, we developed a novel score for the prediction of rhythm outcomes after single AF ablation demonstrating superiority to other scores. The current study was performed to 1) prove the predictive value of the APPLE score in patients undergoing repeat AF ablation and 2) compare it with the CHADS₂ and CHA₂DS₂-VASc scores.

Methods

Rhythm outcome between 3–12 months after AF ablation were documented. The APPLE score (one point for Age >65 years, Persistent AF, imPaired eGFR (<60 ml/min/1.73m²), LA diameter ≥43 mm, EF <50%) was calculated in every patient before procedure.

Results

379 consecutive patients from The Leipzig Heart Center AF Ablation Registry (60±10 years, 65% male, 70% paroxysmal AF) undergoing repeat AF catheter ablation were included. Arrhythmia recurrences were observed in 133 patients (35%). While the CHADS₂ (AUC 0.577, p = 0.037) and CHA₂DS₂-VASc scores (AUC 0.590, p = 0.015) demonstrated low predictive value, the APPLE score showed better prediction of arrhythmia recurrences (AUC 0.617, p = 0.002) than other scores (both p<0.001). Compared to patients with an APPLE score of 0, the risk (OR) for arrhythmia recurrences was 2.9, 3.0 and 6.0 (all p<0.01) for APPLE scores 1, 2, or ≥3, respectively.

Conclusions

The novel APPLE score is superior to the CHADS₂ and CHA₂DS₂-VASc scores for prediction of rhythm outcomes after repeat AF catheter ablation. It may be helpful to identify patients with low, intermediate or high risk for recurrences after repeat procedure.