Renal Dysfunction, Stroke Risk Scores (CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 ), and the Risk of Thromboembolic Events After Catheter Ablation of Atrial Fibrillation

Background— There are limited data on the predictive value of stroke risk scores for thromboembolic events (TEs) after catheter ablation of atrial fibrillation (AF). Our objectives were to report the incidence of TEs after AF ablation in a large contemporary AF ablation cohort and to investigate the impact of renal dysfunction and the value of stroke risk stratification scores (CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 ) for predicting TE after AF ablation. Methods and Results— Using the Leipzig Heart Center AF Ablation Registry, we documented TEs in patients undergoing radiofrequency AF catheter ablation. TE was defined as stroke, transient ischemic attack, or systemic embolism. Study population (N=2069; 66% men; 60±10 years; 62% paroxysmal AF; mean CHADS 2 , 1.2±0.9; CHA 2 DS 2 -VASc, 2.1±1.4; and R 2 CHADS 2 , 1.3±1.1) were followed up for a median 18 (Q1–Q3, 12–29) months (ie, 3078 patient-years). Overall, 31 TEs occurred, with 16 events within 30 days of ablation and 15 TEs (0.72%) during the follow-up period. On multivariate analysis, CHADS 2 ( P 2) and had the best predictive value in patients with AF recurrences (c-index 0.894, P =0.022 versus CHADS 2 , P =0.031 versus R 2 CHADS 2 ). Conclusions— CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 scores were associated with TE risk. The CHA 2 DS 2 -VASc score differentiated TE risk in the low-risk strata based on CHADS 2 and R 2 CHADS 2 scores and may be superior in the subgroup with AF recurrences.