Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Abstract

Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), Catheter-ablation (CA) is superior to antiarrhythmic drugs (AADs) in patients with symptomatic atrial fibrillation (AF), but AF may re-occur despite multiple re-do procedures and recent technical improvements 1,2 . Most arrhythmia recurrences are identified within the first year after the procedure, while further long-term follow-up strategy for initially "successfully" treated patients is less well defined and inconsistently reported 1-9 .Several studies described a progressive increase in the arrhythmia recurrence rates over time in patients with initial post-ablation suppression of AF 4-6 . It is reported that 10-40% of patients who were arrhythmia free within the first post-procedural year experienced very late recurrence of AF (VLRAF) over long-term follow-up 2-9 . Several scoring systems (i.e., the APPLE, ALARMc and BASE-AF2 score) were recently proposed to predict the short-term risk of AF recurrence after the procedure 10-12 . However, none of these scores have addressed VLRAF occurring in patients who were free of AF at 1 year post procedure. Importantly, reliable identification of increased risk of VLRAF could strongly influence decision-making regarding the long-term use of oral anticoagulation and/or AAD therapy as well as the long-term monitoring strategy after the procedure 1,2 . Due to altered risk/benefit ratio, multiple AF ablation procedures may not be justified in patients at high risk of recurrent AF, and reliable prediction of VLRAF could optimize the patient selection for re-do CA 1,2,9,11 .

Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

“…While our study did not independently find the same significant predictors that comprise the BASEAF2 score, BASEAF2 clearly had the best performance in the overall population in our study as well as the PAF and PeAF subgroups. Interestingly, despite using exclusively Very Late Recurrence of Atrial Fibrillation (VLRAF) patients in the creation of their risk score, MB‐LATER performed better than APPLE or ALARMEc, neither of which reached statistical significance . These results indicate the superiority of BASEAF2 to other scores and validate this score in discriminating risk of RAF in an exclusively CBA population.…”

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

“…According to this comparison, MB‐LATER showed better predictive accuracy for VLRAF (AUC 0.782, P < 0.001) than the other scores. Of note, the APPLE score (AUC 0.716, P = 0.002) showed almost similar prediction as the MB‐LATER score …”

“…Each variable scores 1 point. The MB‐LATER score was developed to predict very late recurrences of AF (VLRAF) >12 months after CA …”

“…So far, the APPLE score has been validated in several external cohorts showing similar results as in the development cohort. The third external validation was performed by Mujović et al comparing APPLE with the MB‐LATER score. Both scores showed reasonably good predictive ability in the ROC curve analysis (AUC 0.716, P = 0.002 vs AUC 0.782, P < 0.001) for the prediction of VLRAF.…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice?

“…Atrial fibrillation catheter ablation may not eliminate AF in the majority of patients, but rather attenuate overall AF burden. Follow‐up data beyond 5 or 10 years are limited, and suggest that 2‐5% of “successfully” ablated patients will have recurrences annually . Furthermore, many of these recurrences may be asymptomatic and the prognostic implication of asymptomatic episodes on both stroke risk and cognitive function is unknown .…”