Predicting atrial fibrillation ablation outcome: The CAAP-AF score

Winkle, Roger A.; Jarman, Julian W.E.; Mead, R. Hardwin; Engel, Gregory; Kong, Melissa H.; Fleming, William H.; Patrawala, Rob A.

doi:10.1016/j.hrthm.2016.07.018

Cited by 160 publications

(133 citation statements)

References 26 publications

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“…Of 14 tested clinical variables, six factors (coronary artery disease, left atrial diameter, age, presence of persistent or long‐standing AF, antiarrhythmics failed, and female sex) were significantly associated with AF recurrence after CA. A low CAAP‐AF score (<4 points) was associated with a better long‐term outcome after CA, while high CAAP‐AF score (≥8 points) indicated LA scar and LVAs which are known to increase the recurrence risk . The 2‐year AF‐free rates by CAAP‐AF score values were as follows: 0 = 100%, 1 = 95.7%, 2 = 96.3%, 3 = 83.1%, 4 = 85.5%, 5 = 79.9%, 6 = 76.1%, 7 = 63.4%, 8 = 51.1%, 9 = 53.6%, and ≥ 10 = 29.1%.…”

Section: Rhythm Outcomes After Catheter Ablationmentioning

confidence: 96%

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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Section: Rhythm Outcomes After Catheter Ablationmentioning

confidence: 96%

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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“…The prospectively validated CAAP‐AF scoring system helps clinicians anticipate ablation outcomes for individual patients and comprises of: history of coronary artery disease, atrial diameter size, patient age, AF type (persistent or long‐standing), number of previously failed ADDs and gender . In the present study, outcomes were not affected by any of the above variables (Table ).…”

Section: Resultsmentioning

confidence: 69%

“…Differences in ablation success rates reported in clinical trials are attributable to variables such as AF classification, concomitant risk factors and the definition of success . The AADs most often used in these trials include amiodarone, sotalol, dofetilide and flecainide.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Evaluation of the effect of prior antiarrhythmic drug use on the success of atrial fibrillation catheter ablation

et al. 2019

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What is known and objective Current guidelines recommend catheter ablation (CA) for atrial fibrillation (AF) refractory to at least one antiarrhythmic drug (AAD), but do not specify an adequate number of AADs to be trialed prior to considering ablation. The objective of this study was to evaluate the effect of CA success based on the number of AADs failed in patients with paroxysmal or persistent AF. Methods This retrospective cohort study evaluated patients with paroxysmal or persistent AF who underwent an initial CA at a community hospital. Patients with unknown AAD histories, those who did not achieve acute procedural success, or who were lost to follow‐up or death unrelated to thromboembolic stroke within 6 months post‐ablation were excluded. Catheter ablation success was defined as freedom from AF. The primary outcome was the incidence of AF or atrial flutter captured on an electrocardiogram or other recording device at 3, 6, 9 and 12 months after the procedure. Results and discussion Overall, 99 out of 103 patients completed 1 year of follow‐up. Of those patients, 34 of 99 (34.3%) experienced AF recurrence within 1‐year post‐ablation. There was no significant difference among the categories of number of failed AADs and the recurrence of AF within 12 months post‐ablation for zero AADs, 1 AADs and ≥2 AADs (41.7%, 31.3% and 40%, respectively; P = 0.658). What is new and Conclusion The results of this study do not support preferentially performing CA on patients who have failed a certain number of AADs. Results are limited by the nature of the study design and a small sample size. Conclusive results would best be addressed by a prospective randomized trial.

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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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Predicting atrial fibrillation ablation outcome: The CAAP-AF score

Cited by 160 publications

References 26 publications

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

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

Evaluation of the effect of prior antiarrhythmic drug use on the success of atrial fibrillation catheter ablation

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

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