A novel and simple scoring system for assessing the indication for catheter ablation in patients with atrial fibrillation: The HEAL‐AF Score

Abstract

Introduction A scoring system to determine indications for catheter ablation (CA) in atrial fibrillation (AF) is desired. Methods and Results Among 2898 consecutive patients with AF, CA was performed in 938 (32.4%). A new HEAL‐AF score has been developed by six variables, all of which were independently associated with CA by multivariate analysis and for each 1 point was assigned: heart failure ≥ NYHA II, elderly patients (age ≥75 years), asymptomatic AF, long‐standing persistent AF, atrial dilation (left atrial diameter ≥ 50 mm), and female sex. Low HEAL‐AF score was associated with high incidence of CA performance (52.0% for 0, 36.5% for 1, 15.1% for 2, and 5.6% for ≥ 3) and the predictive capability of this score by AUC of ROC curve was 0.720 (95% CI 0.701‐0.739, P < .001). The rates of freedom from AF/AT recurrence were 73.2% in HEAL‐AF score 0, 71.0% in 1, 60.0% in 2, and 50.0% in ≥ 3 (log‐rank test, P = .004). HEAL‐AF score 2 and ≥ 3 were significantly associated with recurrence of atrial tachyarrhythmia as compared with HEAL‐AF 0 (HR 1.755, P = .002, and HR 2.211, P = .007, respectively). Conclusions A new HEAL‐AF score was associated with patient indication for and the recurrence of atrial tachyarrhythmia after CA in patients with AF. Prescription of CA should be considered carefully in AF patients with HEAL‐AF score of 2 and ≥ 3.