Associations Among the CHADS2 Score, Atrial Substrate Properties, and Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation
Is the CHADS2 score predictive of the efficacy of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation (AF)?
This was a retrospective analysis of 247 patients (mean age 53 years) who underwent RFCA of paroxysmal AF. Patients were categorized according to CHADS2 score: group 1: score 0 (n = 123); group 2: score 1-2 (n = 87); group 3: score 3-6 (n = 37). An electroanatomical mapping system was used to generate a voltage map during sinus rhythm. Circumferential pulmonary vein (PV) isolation was performed and non-PV triggers were ablated. Serial Holter monitors and event monitors were performed during follow-up. A recurrent arrhythmia was defined as an atrial arrhythmia >1 minute in duration ≥2 months post-ablation.
Left and right atrial voltage were the largest in group 1 and the smallest in group 3. During a mean follow-up of 17 months, the recurrence rate was 13% in group 1, 28% in group 2, and 46% in group 3. The CHADS2 score was an independent predictor of outcome after adjustment for left atrial size and other confounders.
Higher CHADS2 scores are associated with lower atrial voltage and are predictive of lower efficacy after RFCA of paroxysmal AF.
The majority of recurrent atrial arrhythmias after RFCA of paroxysmal AF are attributable to reconnection of the PVs. The results of this study suggest that older age and comorbidities such as heart failure, hypertension, and diabetes are associated with atrial substrate changes that make PV isolation less durable.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension
Keywords: Pulmonary Veins, Heart Failure, Breast Neoplasms, Heart Rate, Catheter Ablation, Hypertension, Diabetes Mellitus, Atrial Flutter
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