Development and validation of a risk score for predicting atrial fibrillation recurrence after a first catheter ablation procedure – ATLAS score

Mesquita, João; Ferreira, António Miguel; Cavaco, Diogo; Costa, Francisco; Carmo, Pedro; Marques, Hugo; Morgado, Francisco; Mendes, Miguel; Adragão, Pedro

doi:10.1093/europace/eux265

Cited by 86 publications

(74 citation statements)

References 28 publications

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“…6,7 This has led to a search for predictors of ablation success, such as type of AF, presence of structural heart disease, left atrial size, age, and sex. [8][9][10][11] In our group's experience, a large surge in vagal tone during catheter ablation correlates with a postprocedural increase in resting HR following the ablation procedure. We have also observed that our patients who have significant HR increases at the time of hospital discharge have better outcomes during follow-up.…”

Section: Disruption Of Vagal Reflexes During Pulmonary Vein Isolationmentioning

confidence: 81%

Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

Goff

Laczay

Yenokyan

et al. 2019

Cardiovasc electrophysiol

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Introduction Ablation of atrial vagal ganglia has been associated with improved pulmonary vein isolation (PVI) outcomes. Disruption of vagal reflexes results in heart rate (HR) increase. We investigated the association between HR change after PVI and freedom from atrial fibrillation (AF) at 1 year. Methods and Results Patients who underwent PVI for paroxysmal AF were identified from the Johns Hopkins Hospital AF registry. Electrocardiograms taken pre‐PVI and post‐PVI were used to determine the change in HR. Patients followed‐up at 3, 6, and 12 months. Of 257 patients (66% male, age 59+/‐11 years), 134 (52%) remained free from AF at 1 year. The average HR increased from 60.6 ± 11.3 beats per minute (bpm) pre‐PVI to 70.7 ± 12.0 bpm post‐PVI. Patients with recurrence of AF had lower post‐PVI HR than those who remained free from AF (67.8 ± 0.2 vs 73.3 ± 13.0 bpm; P <.001). The probability of AF recurrence at 1‐year decreased as the change in HR increased (estimated odds ratio [OR], 0.83; 95% confidence interval [CI, 0.74‐0.93]; P = .002). HR increase more than 15 bpm was associated with the lowest odds of AF recurrence (estimated OR, 0.39; 95% [0.17‐0.85]; P = .018) compared to HR decrease. Conclusions Resting HR was found to increase after PVI. Increase in HR more than 15 bpm has a positive association with remaining free from atrial fibrillation at 1 year.

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Section: Disruption Of Vagal Reflexes During Pulmonary Vein Isolationmentioning

confidence: 81%

Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

Goff

Laczay

Yenokyan

et al. 2019

Cardiovasc electrophysiol

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“…Age > 60 years (1 point), type of AF-non-paroxysmal (2 points), indexed left atrial volume (1 point for each 10 mL/m 2 ) female sex (4 points) and current smoking (7 points) were detected as independent predictors for arrhythmia recurrences after CA and they were included in the ATLAS score. 28 3.9 | ABC death risk score Age, heart failure in the clinical history, N-terminal pro-B-type natriuretic peptide, troponin-T, and growth differentiation factor-15 levels were included in the ABC death risk score. 24…”

Section: Atlasmentioning

confidence: 99%

“…The ATLAS score has been developed in a cohort of 1934 AF patients undergoing first CA which were divided into a development and a validation cohort (50% each). 28 9 and was defined as any region with <0.5 mV 23 during electro-anatomical voltage mapping. Voltageguided substrate modification by targeting LVA in addition to circumferential pulmonary vein isolation (PVI) is more effective than conventional PVI ablation approaches concerning arrhythmia freedom after the ablation.…”

Section: Atlasmentioning

confidence: 99%

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

Kosich

Schumacher

Potpara³

et al. 2019

Clinical Cardiology

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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.

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“…In clinical practice, elderly patients are prone to AF recurrence as a result of long‐term progressive atrial scarring. Evidence also shows that advanced age (>60 years for the ATLAS score, >50 years for the CAAP‐AF score) is a contributor to the risk of AF recurrence after catheter ablation, constraining the application of catheter ablation including CBA in the elderly population. The outcome of CBA in the elderly population had not been specifically investigated until 2016.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

Zhang

Ren

Wang

et al. 2019

Cardiovasc electrophysiol

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Introduction Cryoballoon ablation (CBA) results in satisfactory outcomes for drug‐resistant atrial fibrillation (AF) patients. However, the efficacy and safety of CBA have not yet been tested in the Chinese elderly population. Therefore, this study compared the recurrence of AF and complications of CBA in patients ≥75 years and <75 years. Methods A total of 677 patients (<75 years, n = 550; ≥ 75 years, n = 127) with paroxysmal (n = 603) or persistent (n = 74) non‐valvular drug‐resistant AF were included. The efficacy was assessed by the recurrence of AF, and the safety was evaluated by peri‐ and post‐procedural complications. Results The CHA2DS2‐VASc (2.6 ± 1.7 vs 4.8 ± 1.6, P < .01) and HAS‐BLED (1.8 ± 0.8 vs 2.0 ± 0.8, P = .01) scores were significantly higher in the elderly group. The instant pulmonary vein isolation success rate was comparable (99.11% younger vs 98.98% older, P = .99). After a mean follow‐up time of 12.8 ± 9.6 months, the 1‐year freedom from AF rate was 80.6% vs 85.8% in the older and younger groups, respectively, while the survival analysis showed a nonsignificant difference in the rate of freedom from AF (log‐rank P = .46). Cox regression showed that age was not a predictive factor for AF recurrence and was not dichotomized (hazard ratio [HR] = 0.868, 95% confidence interval [CI] 0.509‐1.481; P = .6046) or continuous (HR = 0.990, 95% CI, 0.968‐1.012, P = .3642). Similar complications rates were observed, including stroke (1.0% younger vs 0.93% older, P = .95) and major hemorrhagic events (1.2% younger vs 0% elder, P = .25). Conclusions The efficacy and safety profiles of CBA in patients older than 75 years are comparable with those in younger patients.

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Development and validation of a risk score for predicting atrial fibrillation recurrence after a first catheter ablation procedure – ATLAS score

Abstract: A simple risk score to estimate the rate of AF recurrence after ablation was developed and validated. An external assessment of its usefulness as a patient selection tool seems warranted.

Cited by 86 publications

References 28 publications

Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year

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

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

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