Key result
Simplified clinical score predicts progression to clinical AF with ~0.84 AUC.
Why the study?
Clinical atrial fibrillation progression from atrial high-rate episodes poses significant clinical risks, and a predictive scoring system was needed.
Does a simplified scoring system predict clinical atrial fibrillation progression in patients with atrial high-rate episodes?
Observational (n=209)
Does a simplified scoring system predict clinical atrial fibrillation progression in patients with atrial high-rate episodes?
A novel and simple 5-point clinical score incorporating CHA2DS2-VASc score, left atrial diameter, and AHRE duration offers strong predictive performance (AUC 0.84) for identifying patients at high risk of progressing from AHRE to clinical atrial fibrillation.
Background Clinical atrial fibrillation (AF) progression from atrial high-rate episodes (AHRE) poses significant clinical risks. Objective This study aimed to develop a scoring system to predict clinical AF progression. Methods Patients with documented AHRE but no prior clinical AF were enrolled. A simplified scoring system was developed to predict subsequent clinical AF progression using multivariable logistic regression. Results Among 209 patients with documented AHRE and no prior clinical AF, 37 (17.7%) progressed to clinically documented AF confirmed by 12-lead electrocardiography. Multivariable analysis identified three independent predictors of progression: CHA 2 DS 2 -VASc score >5 (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.4-6.6), left atrial (LA) diameter >46 mm (OR 4.1, 95% CI 1.8-9.2), and longer AHRE duration. Based on these variables, we developed a simplified risk score assigning 1 point for CHA 2 DS 2 -VASc >5, 1 point for LA diameter >46 mm, and 1, 2, or 3 points for AHRE duration >6 minutes, >6 hours, or >24 hours, respectively. The total score ranged from 0 to 5 and showed good discriminative performance, with an area under curve of 0.84 (95% CI 0.7-0.9). A score ≥3 identified patients with an observed clinical AF progression risk of approximately 60% or higher. Over a mean follow-up of 5.5±4.3 years, progression was associated with worse clinical outcomes. Conclusions This simplified scoring system showed high predictive value, effectively stratifying patients by AF progression risk and offering a clinically applicable tool for identifying high-risk individuals.
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Cheng et al. (2026) conducted an observational in Atrial high-rate episodes (AHRE) without prior clinical AF (n=209). Simplified risk score (CHA2DS2-VASc >5, LA diameter >46 mm, AHRE duration) was evaluated on Progression to clinically documented AF confirmed by 12-lead electrocardiography (AUC 0.84, 95% CI 0.7-0.9). A simplified risk score based on CHA2DS2-VASc, left atrial diameter, and AHRE duration accurately predicted progression to clinical atrial fibrillation (AUC 0.84, 95% CI 0.7-0.9).
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