CHA2DS2VASc score as a predictor of ablation success defined by continuous long-term monitoring.

BACKGROUND: There are few reliable risk stratification tools for successful atrial fibrillation catheter ablation (AFCA) and most prior studies have used short-term external monitors to define success. CHA2DS2VASc score may be useful in predicting AF recurrence. We investigated whether CHA2DS2VASc score correlates with AFCA success as measured by continuous monitoring via cardiac implantable electronic devices (CIEDs). METHODS: Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink™ database, we identified patients who underwent a 1st AFCA procedure following CIED implantation. Success was defined as absence of ≥ 1 h of AF following a 3-month blanking period. RESULTS: A total of 632 patients (age 67 ± 9.1 years, 73.3% male, CHA2DS2VASc 3.6 ± 1.8, 36.9% paroxysmal AF) were analyzed and included 35.1% insertable cardiac monitor, 28.8% PPM, 21.4% ICD, 13.6% CRT-D, and 1.1% CRT-P. Success at 24 months post blanking period was 40.3% (95% CI 32.6-49.7%), 36.2% (95% CI 26.9-45.4%), and 21.8% (95% CI 14.6-32.5%) for CHA2DS2VASc subgroups of 0-2, 3-4, and ≥ 5, respectively. Median daily burden of AF was reduced to zero regardless of CHA2DS2VASc score, but there were significant differences in survival free from any AF ≥ 1 h between the three CHA2DS2VASc subgroups (p = 0.013). Patients with a score ≥ 5 had a HR of 1.29 (95% CI 1.00-1.67) for AF recurrence compared to patients with a score of 0-2, with similar results after controlling for AF type. CONCLUSIONS: In real-world patients with continuous monitoring undergoing AFCA, only CHA2DS2VASc scores ≥ 5 predicted higher AF recurrence.

Impact of atrial fibrillation ablation on activity minutes in patients with cardiac implantable electronic devices.

BACKGROUND: Impaired quality of life due to atrial fibrillation (AF), which often includes decreased activity level, is an indication for ablation. However, the impact of ablation for AF on activity is poorly understood. OBJECTIVE: The purpose of this study was to assess the impact of ablation on activity minutes per day using continuous accelerometer data from cardiac implantable electronic devices (CIEDs). METHODS: Using the Optum® Health Record dataset (2007-2019) linked with the Medtronic CareLink® database, we identified patients who had a CIED with AF detection and accelerometer capabilities. Patients with a device that transmitted heart rhythm and activity data ≥3 months before and ≥12 months after ablation were included in analysis. The associations between ablation and activity minutes were assessed for each CIED type. RESULTS: Of 4297 eligible patients who underwent AF ablation, 409 (9.5%) (65% male; age 67.3 ± 9.8 years; 64% paroxysmal AF) were included in analysis. The average AF burden and activity minutes per day preablation were 30.9% ± 37.4% and 175 ± 99 minutes, respectively. After ablation, relative AF burden decreased by 75.1% ± 53.2% (P <.001). There was no change in activity minutes per day after ablation in the entire cohort (average change -0.10 ± 36.2 minutes; P = .96). There were also no clinically significant changes in activity minutes postablation in subgroups based on CIED, season of ablation, quartile of AF burden change, and quartile of age at the time of ablation. CONCLUSION: There were no clinically significant changes in activity minutes per day in patients with CIEDs after ablation for AF.