Validation of seven risk scores in an independent cohort: the challenge of predicting recurrence after atrial fibrillation ablation

ABSTRACT

Purpose@#Several predictive scores for atrial fibrillation (AF) recurrence after AF ablation have been developed. We compared the predictive value of seven previously described risk scores ((CHADS 2 and ­CHA 2 DS 2 -VASC, HATCH, APPLE, CAAP-AF, BASE-AF2, MB-LATER) for prediction of AF recurrence risk at 12 months after AF ablation in our patient cohort. Further, we aimed to identify additional variables to predict recurrences after AF ablation. @*Methods@#We used data from our digital AF ablation registry to compare the previously published scores in an independent cohort (n = 883, 50.8% with paroxysmal AF). The scores were chosen based on earlier publications and availability of relevant data. @*Results@#The BASE-AF2 (AUC 0.630, p < 0.001), MB-LATER (AUC 0.612, p < 0.001), CAAP-AF (AUC 0.591, p < 0.001), APPLE (AUC 0.591, p < 0.001) and CHA2DS2-VASC (AUC 0.547, p = 0.018) scores had a statistically significant but modest pre‑ dictive value for 12-month AF recurrence. None of the scores were significantly superior. Other analyzed scores had no predictive value. There was no difference in the predictive value for 12-month recurrence of AF between first pro‑ cedure vs. redo procedure and RF ablation vs. cryoablation. Unlike other scores, MB-LATER showed better predictive value for paroxysmal vs. persistent AF (AUC 0.632 vs. 0.551, p = 0.038). In the multivariate logistic regression, only age (p = 0.006), number of prior electrical cardioversions (p < 0.001) and early AF recurrence (p < 0.001) were independent predictors of AF recurrence. @*Conclusion@#Despite numerous available scores, predicting recurrences after AF ablation remains challenging. New predictors are needed, potentially based on interventions, as well as novel genetic, functional and anatomic parameters.