Prediction of electro-anatomical substrate and arrhythmia recurrences using APPLE, DR-FLASH and MB-LATER scores in patients with atrial fibrillation undergoing catheter ablation

Abstract

Arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) cause intensive treatment costs. Left atrial electro-anatomical remodeling measured as low voltage areas (LVA) during catheter ablation indicates advanced disease stage and is associated with poor ablation success. The aim of this study was to analyze the prediction of LVA and arrhythmia recurrences using APPLE, DR-FLASH and MB-LATER scores. APPLE, DR-FLASH scores were calculated at baseline and MB-LATER at 3 months post-ablation in AF patients undergoing first catheter ablation. LVA was determined using high-density maps and defined as <0.5 mV. Early (ERAF, <3 months) and late (LRAF, 3–12 months) were analyzed during follow-up. The study population included 241 patients (age 64 ± 11 years, 59% males, 59% persistent AF, 27% LVA, 27% LRAF). LVA were significantly associated with recurrences (OR 2.081, p = 0.026). While on univariable analysis, all scores were significantly associated with LVA, on multivariable analysis only APPLE (OR 1.789, p < 0.001) and DR-FLASH (OR 2.144, p < 0.001) remained significant predictors. However, MB-LATER (OR 1.445, p = 0.034) and ERAF (OR 5.078, p < 0.001) remained associated with LRAF on the multivariable analysis. These results were validated in a subgroup of 873 patients (age 61 ± 10, 63% males, 39% persistent AF, 34% LRAF, 27% LVA) from The Leipzig Heart Center AF Ablation Registry. All scores were significantly associated with recurrences. However, ERAF was the most powerful predictor for later rhythm outcomes. Summarizing, a clinical score useful for prediction for both LVA and rhythm outcomes in AF patients remains a clinical unmet need.

Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score

“…The ZAQ score of 2 points accurately identified the presence and the extent of LVZs (area under the curve [AUC], 0.809; 95% confidence interval [CI], 0.758-0.861; P < .001 and 3 [interquartile range, IQR, 1.5-4.5] vs 7 cm 2 [IQR 4-9]; P = .001). In a validation cohort of 103 patients, the predictive value of the score was confirmed (AUC, 0.793; 95% CI, 0.709-0.878; P < .001 and 4 [IQR, 2-7] vs 11.5 cm 2 [IQR,[8][9][10][11][12][13][14][15][16].5]; P = .001).…”

“…Recently, a number of scores (eg, DR‐FLASH [(D)iabetes mellitus, (R)enal dysfunction, Persistent A(F), (L)eft atrial diameter, (A)ge, (S)ex, (H)ypertension]) using linear measurements obtained from two‐dimensional (2D) echocardiographic images have been proposed to predict the presence of LA substrate 12 . The aims of this study were to investigate whether computed tomography (CT)‐left atrial volume index (LAVI), used as a reference standard in the current guidelines for LA assessment, 13 correlates better with LA‐LVZs than 2D echocardiography‐derived LA diameters, and to develop a simple score based on objective parameters that reliably predict LA‐LVZs.…”

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

“…However, the MB-LATER score (OR 1.445, P = 0.034) and ERAF (OR 5.078, P < 0.001), but not the APPLE score, were associated with LRAF on multivariable analysis. 50 All scores were significantly associated with recurrences, but ERAF was the most powerful predictor for later rhythm outcomes. In summary, on multivariable analysis the APPLE score was associated with prediction of both LVA and arrhythmia recurrences, whereas, as expected, DR-FLASH score ("a substrate score") showed the best prediction for LVA, but not for rhythm outcomes, and MB-LATER was significantly associated with rhythm outcomes, but not LVA.…”

“…While on univariable analysis all scores were significantly associated with LVA, on multivariable analysis only the APPLE (OR 1.789, P < 0.001) and DR‐FLASH scores (OR 2.144, P < 0.001) remained significant predictors. However, the MB‐LATER score (OR 1.445, P = 0.034) and ERAF (OR 5.078, P < 0.001), but not the APPLE score, were associated with LRAF on multivariable analysis . All scores were significantly associated with recurrences, but ERAF was the most powerful predictor for later rhythm outcomes.…”

“…48,49 This correlation had also been shown in our recent study where the APPLE, DR-FLASH, and MB-LATER scores were compared regarding their predictive ability for LVA and recurrences. 50 First, we analyzed this prediction in the BioAF cohort of 214 AF patients and then validated the results in a retrospective cohort from The Leipzig…”