Key result
Several clinical risk scores demonstrated statistically significant but modest predictive value for 12-month atrial fibrillation recurrence after ablation, with the BASE-AF2 score achieving the highest AUC of 0.630.
Why the study?
Several predictive scores for AF recurrence after AF ablation have been developed, but their comparative predictive value required validation in an independent cohort.
Do clinical risk scores (CHADS2, CHA2DS2-VASC, HATCH, APPLE, CAAP-AF, BASE-AF2, MB-LATER) accurately predict atrial fibrillation recurrence at 12 months after ablation?
Observational (n=883)
Open-label
No
Do clinical risk scores (CHADS2, CHA2DS2-VASC, HATCH, APPLE, CAAP-AF, BASE-AF2, MB-LATER) accurately predict atrial fibrillation recurrence at 12 months after ablation?
Effect estimate: AUC 0.630 (for BASE-AF2 score)
p-value: p=<0.001
Existing clinical risk scores have only modest predictive value for atrial fibrillation recurrence after ablation, highlighting the need for novel predictive parameters.
Risk scores' modest accuracy cautions against routine clinical use for ablation planning; leaves open development of stronger predictors.
Several predictive scores for atrial fibrillation (AF) recurrence after AF ablation have been developed. We compared the predictive value of seven previously described risk scores ((CHADS 2 and CHA 2 DS 2 -VASC, HATCH, APPLE, CAAP-AF, BASE-AF2, MB-LATER) for prediction of AF recurrence risk at 12 months after AF ablation in our patient cohort. Further, we aimed to identify additional variables to predict recurrences after AF ablation. We used data from our digital AF ablation registry to compare the previously published scores in an independent cohort ( n = 883, 50.8% with paroxysmal AF). The scores were chosen based on earlier publications and availability of relevant data. The BASE-AF2 (AUC 0.630, p < 0.001), MB-LATER (AUC 0.612, p < 0.001), CAAP-AF (AUC 0.591, p < 0.001), APPLE (AUC 0.591, p < 0.001) and CHA2DS2-VASC (AUC 0.547, p = 0.018) scores had a statistically significant but modest predictive value for 12-month AF recurrence. None of the scores were significantly superior. Other analyzed scores had no predictive value. There was no difference in the predictive value for 12-month recurrence of AF between first procedure vs. redo procedure and RF ablation vs. cryoablation. Unlike other scores, MB-LATER showed better predictive value for paroxysmal vs. persistent AF (AUC 0.632 vs. 0.551, p = 0.038). In the multivariate logistic regression, only age ( p = 0.006), number of prior electrical cardioversions ( p < 0.001) and early AF recurrence ( p < 0.001) were independent predictors of AF recurrence. Despite numerous available scores, predicting recurrences after AF ablation remains challenging. New predictors are needed, potentially based on interventions, as well as novel genetic, functional and anatomic parameters.
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Filipovic et al. (2022) conducted an observational in Atrial fibrillation (n=883). Clinical risk scores (BASE-AF2, MB-LATER, CAAP-AF, APPLE, CHA2DS2-VASC, CHADS2, HATCH) was evaluated on Prediction of atrial fibrillation recurrence at 12 months after ablation (AUC 0.630 (for BASE-AF2 score), p=<0.001). Several clinical risk scores demonstrated statistically significant but modest predictive value for 12-month atrial fibrillation recurrence after ablation, with the BASE-AF2 score achieving the highest AUC of 0.630.
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