Development and validation of a risk score for predicting atrial fibrillation recurrence after a first catheter ablation procedure - ATLAS score.

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/m2). 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.

• Authors: João Mesquita, António Miguel Ferreira, Diogo Cavaco, Francisco Moscoso Costa, Pedro Carmo, Hugo Marques, Francisco Morgado, Miguel Mendes, Pedro Adragão
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 20 Issue FI_3 Pg. f428-f435 (11 01 2018) ISSN: 1532-2092 [Electronic] England
• PMID: 29016770 (Publication Type: Journal Article, Multicenter Study, Observational Study, Validation Study)

Topics

• Age Factors
• Aged
• Atrial Fibrillation (diagnosis, physiopathology, surgery)
• Catheter Ablation (adverse effects)
• Decision Support Techniques
• Electrocardiography, Ambulatory
• Female
• Humans
• Male
• Middle Aged
• Portugal
• Predictive Value of Tests
• Pulmonary Veins (physiopathology, surgery)
• Recurrence
• Registries
• Reproducibility of Results
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sex Factors
• Smoking (adverse effects)
• Time Factors
• Treatment Outcome