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 ((CHADS2 and CHA2DS2-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 predictive 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 procedure 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.