Key result
An LR score predicts ~45% higher risk of late AF recurrence after RFCA per point.
Why the study?
The benefits of radiofrequency catheter ablation for AF decrease with late recurrence, prompting the need for a scoring system based on clinical and echocardiographic parameters to identify patient risk.
Cohort (n=2,352)
No
Hazard Ratio: 1.45 (95% CI 1.38–1.53)
p-value: p=<0.001
A comprehensive scoring system incorporating clinical history and echocardiographic parameters (such as LA diameter and E/e') can effectively stratify the risk of late recurrence after first-time AF ablation.
May aid post-ablation AF risk stratification; extends prior models but remains hypothesis-generating pending validation.
The benefits of radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) significantly decrease with late recurrence (LR). We aimed to develop a scoring system to identify patients at high and low risk for LR following RFCA, based on a comprehensive evaluation of multiple risk factors for AF recurrence, including echocardiographic parameters. We studied 2,352 patients with AF undergoing first-time RFCA in a single institution. The LR-free survival rate up to 5 years was measured using a Kaplan-Meier analysis. The influence of clinical and echocardiographic parameters on LR was calculated with a Cox-regression analysis. Duration of AF ≥4 years (hazard ratio [HR] = 1.75; p < 0.001), non-paroxysmal AF (HR = 3.18; p < 0.001), and diabetes (HR = 1.34; p = 0.015) were associated with increased risk of LR. Left atrial (LA) diameter ≥45 mm (HR = 2.42; p < 0.001), E/e' ≥ 10 (HR = 1.44; p < 0.001), dense SEC (HR = 3.30; p < 0.001), and decreased LA appendage flow velocity (≤40 cm/sec) (HR = 2.35; p < 0.001) were echocardiographic parameters associated with increased risk of LR following RFCA. The LR score based on the aforementioned risk factors could be used to predict LR (area under curve = 0.717) and to stratify the risk of LR (HR = 1.45 per 1 point increase in the score; p < 0.001). In conclusion, LR after RFCA is affected by multiple clinical and echocardiographic parameters. This study suggests that combining these multiple risk factors enables the identification of patients with AF at high or low risk for having arrhythmia recurrence.
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Kim et al. (2019) conducted a cohort in Atrial Fibrillation (n=2,352). LR score (clinical and echocardiographic risk factors) vs. Lower LR score was evaluated on Late recurrence of atrial fibrillation after the last radiofrequency catheter ablation (HR 1.45, 95% CI 1.38-1.53, p=<0.001). An LR score combining clinical and echocardiographic risk factors significantly predicted late recurrence of atrial fibrillation after radiofrequency catheter ablation, with a 45% increased risk per 1-point increase (HR 1.45).
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