Time-dependent prediction of arrhythmia recurrences during long-term follow-up in patients undergoing catheter ablation of atrial fibrillation: The Leipzig Heart Center AF Ablation Registry

Abstract

The prediction of arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. The aim of current analysis was to investigate the time-dependent prediction of arrhythmia recurrences after AF catheter ablation during long-term follow-up. The study included 879 patients (61 ± 10 years; 64% males; 39% persistent AF) undergoing first AF catheter ablation. Rhythm outcomes were documented using 7-days Holter monitoring. The APPLE score (Age, Persistent AF, imPaired eGFR, Left atrium (LA), EF) was calculated at baseline, while MB-LATER score (Male gender, Bundle branch block, LA, AF Type, Early Recurrences) 3 months after ablation. The median follow-up time was 37 months [95%CI 35;39]. ERAF and LRAF occurred in 45% and 64%, respectively. On multivariable analysis, ERAF (HR 2.095, 95%CI 1.762–2.490, p < 0.001) was strongly associated with LRAF. The APPLE (HR 1.385, 95%CI 1.276–1.505, p < 0.001) and MB-LATER (HR 1.326, 95%CI 1.239–1.419, p < 0.001) scores significantly predicted LRAF during follow-up. On the ROC analysis, APPLE (AUC 0.640, 95%CI 0.602–0.677, p < 0.001) and MB-LATER (AUC 0.654, 95%CI 0.616–0.691, p < 0.001) demonstrated moderate prediction. Summarizing, ERAF was the strongest predictor for LRAF in time-dependent manner. The APPLE and MB-LATER scores demonstrated moderate prediction of arrhythmia recurrences during long term follow-up.

Response to the Letter: The NT‐proANP puzzle ‐ a small piece that makes the big picture

“…1 Based on our previous investigation, prediction of electro-anatomical substrate before catheter ablation seems to be more important for individualized AF management than arrhythmia recurrences, which partly depends on ablators' experience and follow-up strategies. 2 However, we agree that late gadolinium enhancement (LGE) and presence of LVAs do not necessarily overlap. Indeed, there are some technical issues and anatomical challenges for the electro-anatomical mapping.…”

Effect of outcome measures on the apparent efficacy of ablation for atrial fibrillation: Why “success” is an inappropriate term

“…These factors have been incorporated into various scores such as the APPLE, ATLAS, DR-FLASH and MB-LATER scores that could give a patient a percentage likelihood that they would be free from any AF at one year between 19% to 71%. Although these scores were developed to predict recurrence at difference time points and despite both the APPLE and MB-LATER scores being the only ones validated in external cohorts, both these scores still had modest predictive capacity on ROC analysis (AUC 0.64 and 0.65 for APPLE and MB LATER respectively) 24 . The number of different scores developed, however, demonstrates the differences in predictive variables in different populations and these predictions have wide confidence intervals for individual cases.…”

Short-Time Estimation of Fractionation in Atrial Fibrillation with Coarse-Grained Correlation Dimension for Mapping the Atrial Substrate

“…After the first reference on the arrhythmogenic role of pulmonary veins (PVs) [ 8 ] more than twenty years ago, catheter ablation (CA) targeting PVs foci, a procedure called pulmonary vein isolation (PVI), became the most popular of these treatments. Despite the well-established dominion of this technique up to present, the AF recurrence rate in patients with peAF remains higher than 50% in many cases [ 9 , 10 ].…”