Comparison of six risk scores for the prediction of atrial fibrillation recurrence after cryoballoon‐based ablation and development of a simplified method, the 0‐1‐2 PL score

Abstract

Introduction There are several prognostic scores for the assessment of risk of atrial fibrillation (AF) recurrence post ablation procedure. However, the use of these complex scores is difficult and the validation on different populations brought divergent results. Our goal was to compare the performance of these risk scores as the basis for the development of a new, simplified score based only on few universally predictive variables. Methods All cryoballoon‐based AF ablations performed in a single‐center over a 10‐year period were prospectively analyzed with regard to AF recurrence. This served to analyze the performance of APPLE, CAAP‐AF, SCALE‐CryoAF, MB‐LATER, CHADS2, and CHA2DS2‐VASc risk scores. Results A total of 597 patients, mostly (78.1%) with paroxysmal AF were studied. Analyzed risk scores performed poorer than in the original publications because some risk factors were not predictive of AF recurrence. A simplified score named 0‐1‐2 PL, composed of just two universally predictive variables, AF type (1 point for Persistent AF) and LA dimension (1 point for LA size >45 mm) was developed. The 0‐1‐2 PL score stratified patients into low risk (0 points), intermediate risk (1 point), and high risk categories (2 points) which were related to a 2‐year risk of AF recurrence of 21%, 37%, and 55%, respectively. This score had C‐statistics (0.620) higher/comparable to other investigated much more complex scores. Conclusion The assessment of risk of AF recurrence at the pre‐ablation stage can be simplified without compromising accuracy. This could help to popularize risk assessment and standardization of AF management.

Validation of seven risk scores in an independent cohort: the challenge of predicting recurrence after atrial fibrillation ablation

“…Our results are consistent with the two recent studies comparing AF recurrence risk prediction scores, which also showed only modest predictive value for all scores [13,14]. This underscores the ongoing challenge of predicting AF recurrence after AF ablation.…”

“…Several predictive scores for AF recurrence after ablation have been developed. The predictive value of such scores has thus far been limited [13,14].…”

“…All scores, except the HATCH score, demonstrated statistically significant but poor predictive value for recurrent AF after ablation (AUC 0.553-0.669). Jastrzębski et al compared 6 scores (APPLE, CAAP-AF, SCALE-CryoAF, MB-LATER, CHADS 2 and CHA 2 DS 2 -VASc) on a cohort of 597 patients undergoing AF balloon cryoablation and used the insights as basis for development of a simplified risk score [14]. All scores showed significant but poor predictive value (AUC 0.551-0.624).…”

Validation of the SCALE-CryoAF risk model to predict very late return of atrial fibrillation after cryoballoon ablation

“…Specifically, the BASE-AF2 score was designed to assess recurrence of AF at extended follow-up after CBA. In addition, a recent study by Jastrzebski and colleagues evaluated the efficacy of various risk scores in predicting recurrence of AF over 10 years after ablation [ 21 ]. In their cohort of 617 consecutive patients who underwent catheter ablation, SCALE-CryoAF predicted recurrent AF over 10 years post ablation better than APPLE, CAAP-AF, CHADS 2 , CHA 2 DS 2 -VASc, and MB-LATER [ 21 ].…”

“…In addition, a recent study by Jastrzebski and colleagues evaluated the efficacy of various risk scores in predicting recurrence of AF over 10 years after ablation [ 21 ]. In their cohort of 617 consecutive patients who underwent catheter ablation, SCALE-CryoAF predicted recurrent AF over 10 years post ablation better than APPLE, CAAP-AF, CHADS 2 , CHA 2 DS 2 -VASc, and MB-LATER [ 21 ]. However, neither of the aforementioned studies specifically evaluated for VLRAF after CBA and instead included patients with recurrent AF within one year after ablation in their analyses.…”