Predictive Value of the HELT-E₂S₂ Score for Clinical Outcomes After Catheter Ablation for Atrial Fibrillation　― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=769). Intervention: HELT-E2S2 score vs. Lower HELT-E2S2 score. Primary outcome: Atrial fibrillation recurrence after catheter ablation beyond the 3-month blanking period (HR 1.26, 95% CI 1.06-1.49, p=0.007).

K Tanaka; Ayako Okada; Masatoshi Minamisawa; Toshinori Komatsu; Hideki Kobayashi; Takahiro Okano; Yasutaka Oguchi; Hiroaki Tabata; Wataru Shoin; Yasumasa Nohno; Tatsuya Usui; Takahiro Takeuchi; Masao Hirabayashi; Yuichi Katagiri; Toshio Kasai; Ryosuke Kozu; Yasushi Wakabayashi; Yasushi Ueki; Koji Yoshie; Tamon Kato; Tatsuya Saigusa; Soichiro Ebisawa; Koichiro Kuwahara

doi:10.1253/circrep.cr-25-0261

Key result

Higher HELT-E2S2 score linked to ~26% higher AF recurrence risk per point after ablation.

HR 1.26
95% CI 1.06-1.49
P=0.007
n=769

Figures

Why the study?

The HELT-E2S2 score is a new risk assessment tool for ischemic stroke in Japanese patients with atrial fibrillation, and its association with clinical outcomes after catheter ablation for AF was investigated.

Does the HELT-E2S2 score predict atrial fibrillation recurrence in patients undergoing catheter ablation?

Key Points

To evaluate whether the HELT-E2S2 score, originally designed to assess ischemic stroke risk in Japanese patients with atrial fibrillation, predicts arrhythmia recurrence after catheter ablation.
Subanalysis of 769 patients undergoing first-time catheter ablation for atrial fibrillation enrolled in the multicenter Shinshu-AB Registry across 10 hospitals in Nagano, Japan.
Patients were categorized into 4 risk tiers by HELT-E2S2 score: score 0 (group 1, n=155), score 1 (group 2, n=287), score 2 (group 3, n=216), and score ≥3 (group 4, n=111).
Atrial fibrillation recurrence was assessed beyond a 3-month blanking period during a 1-year follow-up using 12-lead electrocardiograms or 24-hour Holter monitoring.
Atrial fibrillation recurred in 170 patients (22.1%), with higher HELT-E2S2 scores significantly associated with increased recurrence rates (log-rank P=0.003).
After multivariable adjustment, group 4 (score ≥3) exhibited an increased risk of recurrence compared with group 1 (HR, 2.03; 95% CI, 1.03–4.00; P=0.041).
Modeled as a continuous variable, the HELT-E2S2 score remained independently associated with recurrence after multivariable adjustment (HR, 1.26; 95% CI, 1.06–1.49; P=0.007).

Study Design

Type

Observational (n=769)

Multicenter

Yes

Structured PICO

Does the HELT-E2S2 score predict atrial fibrillation recurrence in patients undergoing catheter ablation?

P

Population

769 Japanese patients (median age 70, 31.2% female) undergoing first-time catheter ablation for atrial fibrillation, followed for 1 year.

E

Exposure

Risk stratification using the HELT-E2S2 score in patients undergoing catheter ablation for atrial fibrillation

C

Comparator

Patients with lower HELT-E2S2 scores (score 0 vs scores 1, 2, and ≥3)

O

Outcome

Atrial fibrillation recurrence after catheter ablation beyond the 3-month blanking period during a follow-up period of up to 1 year

Main Result

Hazard Ratio: 1.26 (95% CI 1.06–1.49)

p-value: p=0.007

The HELT-E2S2 score, originally designed for stroke risk assessment, is also a significant predictor of atrial fibrillation recurrence after catheter ablation.

Limitations

Post-hoc analysis with potential unmeasured confounding factors
None of the patients achieved the maximum HELT-E2S2 score of 7, potentially affecting the findings
Short follow-up period (1 year for recurrence, 1 month for safety) did not assess long-term cardiovascular and stroke events
Conducted before the introduction of pulsed-field ablation (PFA), limiting applicability to newer ablation technologies

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Implication

Should not yet guide post-ablation decisions; extends HELT-E2S2 to recurrence prediction but leaves open its incremental utility.

Abstract

Background: score is a new risk assessment tool for ischemic stroke in Japanese patients with atrial fibrillation (AF), so we investigated its association with clinical outcomes after catheter ablation (CA) for AF. Methods and Results: score was associated with AF recurrence after multivariable adjustment (HR, 1.26; 95% CI, 1.06-1.49; P=0.007). Conclusions: scores were associated with an increased risk of AF recurrence after CA.

Discussion

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Cite This Study

Tanaka et al. (2025) conducted an observational in Atrial fibrillation (n=769). HELT-E2S2 score vs. Lower HELT-E2S2 score was evaluated on Atrial fibrillation recurrence after catheter ablation beyond the 3-month blanking period (HR 1.26, 95% CI 1.06-1.49, p=0.007). Higher HELT-E2S2 scores were associated with an increased risk of atrial fibrillation recurrence after catheter ablation, with a.26 per 1-point score increase.

synapsesocial.com/papers/6963224191e05aa366cb8d73 https://doi.org/10.1253/circrep.cr-25-0261

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Predictive Value of the HELT-E₂S₂ Score for Clinical Outcomes After Catheter Ablation for Atrial Fibrillation　― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Predictive Value of the HELT-E₂S₂ Score for Clinical Outcomes After Catheter Ablation for Atrial Fibrillation　― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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Keep reading

Predictive Value of the HELT-E₂S₂ Score for Clinical Outcomes After Catheter Ablation for Atrial Fibrillation ― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Predictive Value of the HELT-E₂S₂ Score for Clinical Outcomes After Catheter Ablation for Atrial Fibrillation ― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading

Predictive Value of the HELT-E₂S₂ Score for Clinical Outcomes After Catheter Ablation for Atrial Fibrillation　― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―

Predictive Value of the HELT-E₂S₂ Score for Clinical Outcomes After Catheter Ablation for Atrial Fibrillation　― Subanalysis of the Shinshu Catheter Ablation (Shinshu-AB) Registry ―