Clinical scores used for the prediction of negative events in patients undergoing catheter ablation for atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in adults. Catheter ablation (CA) is one of the most important management strategies to reduce AF burden and AF‐associated complications. In order to stratify the risk of adverse events and to predict treatment success in AF patients undergoing CA, several risk stratification scores had been developed during the last decade. The aim of this review is to provide an overview of the most important clinical risk scores predicting rhythm outcomes, electro‐anatomical substrate and mortality in AF.

Recurrence of Atrial Fibrillation in Dependence of Left Atrial Volume Index

“…As displayed in our results, heart failure, diastolic dysfunction and AF form a vicious circle, promoting LA enlargement via increased diastolic pressure, thus leading to atrial remodeling, which begets AF (36). Impaired renal function, as shown in this analysis, is also a risk factor for AF recurrence, reflecting the role of the cardio-renal system, as it gets influenced by cardiac remodeling, metabolic abnormalities and oxidative stress (34,36,37). There was no difference in our study with respect to concomitant medication, except for digitalis.…”

“…While sex didn't show any significant difference in this patient cohort, it has been reported that female sex is a risk factor for AF recurrences (32). Increased BMI, diabetes, history of cerebrovascular events and coronary artery disease show conflicting data in the literature, thus a single component effect can't be specified, but in combination with other risk factors and integrated in scores, a relevant effect can be yielded (32)(33)(34). Hypertension and heart failure, including an often detected HFpEF compared to HFrEF in the recurrence group, in combination with an increased NYHA score, are general risk factors for AF recurrence (32,33,35).…”

“…The duration of AF is significantly linked to the recurrence of AF, most likely due to level of atrial remodeling and fibrosis, which indicates paroxysmal AF as a positive predictor for restoring the sinus rhythm (32,36). An increased CHA 2 DS 2 -VASc-Score, which characterizes cardiovascular risk factors, is not just a score for thromboembolic risk but it also predicts mortality in cardiac patients and as well AF recurrence (34,38). Patients with a higher CHA 2 DS 2 -VASc score are, therefore, not only at stake for thromboembolic events but also for AF itself (39,40).…”

Time-dependent prediction of arrhythmia recurrences during long-term follow-up in patients undergoing catheter ablation of atrial fibrillation: The Leipzig Heart Center AF Ablation Registry

“…Also, only few scores had such a quality criterion as the external validation. In AF patients undergoing radiofrequency ablation only APPLE and MB-LATER scores were validated in several external cohorts 13 .…”

“…There have been multiple studies analysing the impact of different scores on recurrence prediction – from the CHADS 2 and CHA 2 DS 2 -VASc scores (designed for the thromboembolic risk prediction) to the specific rhythm outcomes prediction scores as ALARMEC, BASE-AF2, CAAP-AF, ATLAS and LAGO 6–13 .…”