A novel risk model for very late return of atrial fibrillation beyond 1 year after cryoballoon ablation: the SCALE-CryoAF score.

PURPOSE: Cryoballoon ablation (CBA) is an effective technique for pulmonary vein isolation (PVI). To date, there are no risk models to predict very late recurrence of atrial fibrillation (VLRAF) after CBA. METHODS: Retrospective analysis of a single-center database was performed. Inclusion criteria included PVI using CBA for atrial fibrillation (AF) without additional ablation targets, follow-up > 365 days, and no recurrent AF between 90 and 365 days after procedure. The primary endpoint was recurrent AF > 30 s > 12 months post-CBA. A risk model was created using clinical variables. RESULTS: Of 674 CBA performed from 2011 to 2016, 300 patients (200 male, 62.0 ± 9.9 years) met inclusion criteria. Of these, 159 (53.0%) patients had paroxysmal AF. Patients had an average of 9.5 ± 2.7 cryoballoon freezes, and no patients required additional radiofrequency ablation lesion sets. Over a follow-up of 995 ± 490 days, 77/300 (25.7%) patients exhibited VLRAF. Univariate and multivariate analyses demonstrated that Structural heart disease (1 point), Coronary artery disease (3 points), left Atrial diameter > 43 mm (1 point), Left bundle branch block (3 points), Early return of AF (4 points), and non-paroxysmal AF (3 points) were risk factors for VLRAF. Combining these variables into a risk model, SCALE-CryoAF, (min 0; max 15) predicted VLRAF with an area under the curve of 0.73. CONCLUSION: SCALE-CryoAF is the first risk model to specifically predict first recurrence of AF beyond 1 year, VLRAF, after CBA. Model discrimination demonstrates that SCALE-CryoAF predicts VLRAF after CBA significantly better than other risk models for AF recurrence.

Cardiac complications of systemic sclerosis and management: recent progress.

PURPOSE OF REVIEW: Cardiac complications in systemic sclerosis (SSc) continue to be a leading cause of death in this patient population. Early recognition and treatment of the cardiac diseases commonly associated with SSc is essential. RECENT FINDINGS: Recent studies have confirmed the significant increase in mortality in SSc patients with cardiac involvement. Electrocardiography and echocardiography (2DE) continue to play a major role in screening and diagnosing cardiac manifestations such as arrhythmias or biventricular dysfunction, respectively. Novel techniques such as myocardial strain imaging on 2DE and T1 mapping on cardiovascular magnetic resonance are useful for detecting subclinical cardiac abnormalities, but the clinical relevance of these findings is still not known. An expert consensus was recently published to help establish best practice guidelines on management of cardiac complications in SSc, but data supporting these recommendations remain limited. SUMMARY: Recent studies continue to enhance our understanding of SSc cardiac disease. Although the results of these studies help lessen the ambiguity of managing and treating these patients, there is still much more research to be done.