The APPLE score: a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation

Abstract

Background Recurrent atrial fibrillation (AF) occurs in up to 50 % of patients within 1 year after catheter ablation, and a clinical risk score to predict recurrence remains a critical unmet need. The aim of this study was to (1) develop a simple score for the prediction of rhythm outcome following catheter ablation; (2) compare it with the CHADS2 and CHA2DS2-VASc scores, and (3) validate it in an external cohort. Methods Rhythm outcome between 3 and 12 months after AF catheter ablation were documented. The APPLE score [one point for age>65 years, persistent AF, impaired eGFR (<60 ml/min/1.73 m2), LA diameter ≥43 mm, EF < 50 %] was associated with AF recurrence and was validated in an external cohort in 261 patients with comparable ablation and follow-up. Results In 1145 patients (60 ± 10 years, 65 % male, 62 % paroxysmal AF) the APPLE score showed better prediction of AF recurrences (AUC 0.634, 95 % CI 0.600–0.668, p < 0.001) than CHADS2 (AUC 0.538) and CHA2DS2-VASc (AUC 0.542). Compared to patients with an APPLE score of 0, the odds ratio for AF recurrences was 1.73, 2.79 and 4.70 for APPLE scores 1, 2, or ≥3, respectively (all p < 0.05). In the external validation cohort, the APPLE score showed similar results (AUC 0.624, 95 % CI 0.562–0.687, p < 0.001). Conclusions The novel APPLE score is superior to the CHADS2 and CHA2DS2-VASc scores for prediction of rhythm outcome after catheter ablation. It holds promise as a useful tool to identify patients with low, intermediate, and high risk for AF recurrence.

The APPLE Score – A Novel Score for the Prediction of Rhythm Outcomes after Repeat Catheter Ablation of Atrial Fibrillation

“…However, it might be explained by 1) small study population, and 2) by young and relatively ‘healthy’ cohort. Our results are in accordance with previous studies and a recent meta-analysis [3, 6, 7, 14]. It seems that the most powerful predictors for the rhythm outcomes remain persistent AF and LA diameter, while other components of APPLE and ALARMEc scores might be considered as possible mediators for arrhythmia occurrence.…”

“…Both scores were developed using much smaller cohorts of patients undergoing cryoablation compared to our initial cohort [6, 7]. Later, Wojcik and co-authors analyzed the predictive value of the ALARMEc score in patients undergoing repeat catheter ablation demonstrating better prediction than CHADS 2 and CHA 2 DS 2 -VASc scores [3].…”

“…The APPLE score, which is based on clinical variables, is a simple tool with good predictive value and was validated in an external validation set showing similar predictive ability [7]. …”

“…APPLE score, and demonstrated good prediction of arrhythmia recurrences before first ablation [7]. However, whether the APPLE score is useful in prediction of rhythm outcomes in patients following repeat catheter ablation is unknown and was analyzed in this study.…”

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

“…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-up23456789. 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 procedure101112. However, none of these scores have addressed VLRAF occurring in patients who were free of AF at 1 year post procedure.…”