Key result
HWARNER 1 model successfully stratifies risk, with high-scoring patients showing only ~59% 3-year freedom from atrial tachyarrhythmias.
Why the study?
Predictive models for recurrence after AF radiofrequency catheter ablation may help optimize patient selection and post-ablation management.
Does the PVI + LVZs-Stepwise protocol reduce atrial tachyarrhythmias recurrence compared to PVI alone in patients with paroxysmal atrial fibrillation?
Cohort (n=416)
No
Does the PVI + LVZs-Stepwise protocol reduce atrial tachyarrhythmias recurrence compared to PVI alone in patients with paroxysmal atrial fibrillation?
The HWARNER predictive models, incorporating HbA1c and other clinical factors, accurately predict atrial tachyarrhythmia recurrence after AF ablation, highlighting the importance of glycemic control in post-ablation management.
Answers are grounded in this paper and cite their sources.
May refine post-ablation risk stratification using glycemic factors; leaves open whether optimizing HbA1c reduces recurrence.
Predictive models for recurrence following atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) have potential value in minimizing the risk of recurrent atrial tachyarrhythmias (ATAs). This study aims to develop and validate models to optimize patient selection and post-ablation management. A retrospective analysis of consecutive AF patients undergoing RFCA from January 2021 to August 2023 identified risk factors for ATAs recurrence through regression analysis, leading to the development of two predictive models, HWARNER 1 and HWARNER 2, which were preliminarily externally validated. Seven risk factors were identified: Weight > 77.5 kg, HbA1c > 5.75%, RA (dimension / > 46.5 mm), NT-proBNP > 650.18 pg/ml, Early AF recurrence, Redo procedures, and Height > 171.5 cm. Based on these factors, the HWARNER models showed high predictive accuracy with AUCs of 0.775 and 0.773, outperforming established models. Kaplan–Meier analysis revealed significant differences in ATAs recurrence between low- and high-risk groups (HWARNER 1: 93.0% vs. 59.1%, P < 0.001; HWARNER 2: 94.5% vs. 67.9%, P < 0.001) with an median follow-up of one year. In subgroup analysis, HbA1c showed stronger predictive value in patients with BMI > 26.7 (OR = 7.191, 95% CI: 1.375–37.594, P = 0.019). In paroxysmal AF (PAF) patients, the pulmonary vein isolation plus low voltage zones-stepwise (PVI + LVZs-Stepwise) protocol showed no benefit over PVI alone. The HWARNER models have the potential to predict ATAs recurrence after RFCA, providing a valuable tool for patient selection and management. HbA1c is an important independent risk factor.
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Xu et al. (2025) conducted a cohort in Atrial fibrillation (n=416). HWARNER 1 model high-risk classification vs. HWARNER 1 model low-risk classification was evaluated on 3-year freedom from atrial tachyarrhythmias (FFATAs) (p=<0.001). The HWARNER 1 predictive model successfully stratified patients, demonstrating a 3-year freedom from atrial tachyarrhythmias of 59.1% in the high-risk group compared to 93.0% in the low-risk group.
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