Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP‐AF risk scoring systems

Black‐Maier, Eric; Parish, Alice; Steinberg, Benjamin A.; Green, Cynthia L.; Loring, Zak; Barnett, Adam S.; Al‐Khatib, Sana M.; Atwater, Brett D.; Daubert, James P.; Frazier‐Mills, Camille; Hegland, Donald D.; Jackson, Kevin; Jackson, Larry R.; Koontz, Jason I.; Lewis, Robert K.; Pokorney, Sean D.; Sun, Albert Y.; Thomas, Kevin L.; Bahnson, Tristam D.; Piccini, Jonathan P.

doi:10.1111/pace.13805

Cited by 12 publications

(6 citation statements)

References 25 publications

(77 reference statements)

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“…5,6 The clinical scoring system, including CAAP-AF, DR-FLASH and APPLE scores, could provide a realistic AF ablation outcome expectation for individual patients. [7][8][9][10][11] However, this scoring system is simple and requires further modifications for increased robustness via substitution of aetiologic factors by surrogate variables.…”

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confidence: 99%

Shifts in gut microbiome and metabolome are associated with risk of recurrent atrial fibrillation

Zuo

Zhang

et al. 2020

J Cellular Molecular Medi

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Alternations of gut microbiota (GM) in atrial fibrillation (AF) with elevated diversity, perturbed composition and function have been described previously. The current work aimed to assess the association of GM composition with AF recurrence (RAF) after ablation based on metagenomic sequencing and metabolomic analyses and to construct a GM‐based predictive model for RAF. Compared with non‐AF controls (50 individuals), GM composition and metabolomic profile were significantly altered between patients with recurrent AF (17 individuals) and non‐RAF group (23 individuals). Notably, discriminative taxa between the non‐RAF and RAF groups, including the families Nitrosomonadaceae and Lentisphaeraceae, the genera Marinitoga and Rufibacter and the species Faecalibacterium spCAG:82, Bacillus gobiensis and Desulfobacterales bacterium PC51MH44, were selected to construct a taxonomic scoring system based on LASSO analysis. After incorporating the clinical factors of RAF, taxonomic score retained a significant association with RAF incidence (HR = 2.647, P = .041). An elevated AUC (0.954) and positive NRI (1.5601) for predicting RAF compared with traditional clinical scoring (AUC = 0.6918) were obtained. The GM‐based taxonomic scoring system theoretically improves the model performance, and the nomogram and decision curve analysis validated the clinical value of the predicting model. These data provide novel possibility that incorporating the GM factor into future recurrent risk stratification.

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confidence: 99%

Shifts in gut microbiome and metabolome are associated with risk of recurrent atrial fibrillation

Zuo

Zhang

et al. 2020

J Cellular Molecular Medi

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“…Time from diagnosis to ablation is also associated with improved outcomes after ablation. 9,10 Although the likelihood of recurrence of AF is 1 factor that should be considered, it is difficult to predict, 11 and certain patients may derive even greater benefits from catheter ablation, such as in patients with HFrEF, who have been shown to have improved functional status, LV function, and cardiovascular outcomes. 12–14…”

Section: Rhythm Controlmentioning

confidence: 99%

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Joglar,

Chung,

Armbruster

et al. 2024

Circulation

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542

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AIM The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

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“…Several other studies have proposed different composite scores for predicting post-procedural success, such as APPLE [ 14 ], CAAP-AF [ 15 ], MB-LATER [ 16 ], and SUCCESS [ 17 ], but most have not been validated in prospective cohorts [ 18 ]. Moreover, some proposed scores included only intra-procedural or post-ablation variables, with poor predictive power and/or low sensitivity/specificity ratios.…”

Section: Introductionmentioning

confidence: 99%

New Score for Predicting Results after Catheter Ablation for Atrial Fibrillation: VAT-DHF

Nastasă,

Bogdan,

Iorgulescu

et al. 2023

JCM

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Introduction: Catheter ablation (CA) for atrial fibrillation (AF) has been proven to have the highest efficacy in maintaining sinus rhythm. Several studies have proposed different scores for predicting post-procedural success, but most have not been validated in prospective cohorts. Further research is required to determine the optimal formulae. Purpose: This study aimed to identify independent predictors of AF recurrence after CA and develop a composite score. Methods: Consecutive patients with persistent and paroxysmal AF who underwent CA were retrospectively analyzed. The independent predictors of recurrence were used to create a new predictive score. Results: The cohort included 263 patients with a follow-up of 37.6 ± 23.4 months. Persistent AF, f-waves < 0.1 mV, indexed left atrium volume, the presence of type 2 diabetes, and smaller height were independent predictors of recurrence and were used to create a new scoring model, VAT-DHF (V = Volume, AT = AF Type, D = Diabetes, H = Height, F = f waves). The ROC curve for this new score showed an AUC of 0.869, p < 0.0001, 95% CI [0.802–0.936], while those for APPLE and CHA2DS2-VASc showed an AUC of 0.765, 95% CI [0.637–0.893] and an AUC of 0.655, 95% CI [0.580–0.730], respectively. Patients who had a VAT-DHF score between 0 and 3.25, 3.25 and 6, and ≥6, had success rates of 95.7%, 76.3%, and 25% (p < 0.0001), respectively. Conclusions: The novel VAT-DHF score is easy to calculate and may be a useful clinical tool for identifying patients with a low, intermediate, or high risk of AF recurrence after CA.

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Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP‐AF risk scoring systems

Cited by 12 publications

References 25 publications

Shifts in gut microbiome and metabolome are associated with risk of recurrent atrial fibrillation

Shifts in gut microbiome and metabolome are associated with risk of recurrent atrial fibrillation

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

New Score for Predicting Results after Catheter Ablation for Atrial Fibrillation: VAT-DHF

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