Comparison of CHADS2, R2CHADS2, and CHA2DS2-VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation: The Leipzig Heart Center AF Ablation Registry

Study Questions:

What are associations between stroke risk stratification scores and atrial fibrillation (AF)-related variables (left atrial [LA] diameter and AF type) and early and late AF recurrences in a large contemporary AF ablation registry?

Methods:

This was a retrospective analysis of 2,069 patients from the Heart Center Leipzig AF Ablation Registry who underwent AF catheter ablation between 2007 and 2011. AF recurrences were the primary outcomes and were defined as any atrial arrhythmia occurring within the first week (early recurrences, ERAF) and between 3 and 12 months (late recurrences, LRAF) after ablation. Patients had 7-day Holter recordings performed immediately and 3, 6, and 12 months after ablation or when patients’ symptoms were suggestive of AF. Regression analyses were performed to identify predictors for AF recurrences. Receiver operating characteristic (ROC) curves were used to characterize CHADS2, R2CHADS2, and CHA2DS2-VASc scores’ performance in predicting rhythm outcomes.

Results:

ERAF and LRAF occurred in 36% and 33% of patients, respectively. In adjusted analyses, the following were predictors of ERAF: female gender, persistent AF, larger LA diameter, R2CHADS2 score (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02-1.21; p = 0.016), and CHA2DS2-VASc score (OR, 1.09; 95% CI, 1.02-1.17; p = 0.015). After adjustment for ERAF, only R2CHADS2 was a significant predictor for LRAF. Both R2CHADS2 and CHA2DS2-VASc scores showed low predictive value using ROC curve analysis.

Conclusions:

The stroke risk stratification scores R2CHADS2, and CHA2DS2-VASc (but not CHADS2) are associated with rhythm outcomes after catheter ablation, but have limited predictive value. Persistent AF, LA diameter, and ERAF are significant predictors for LRAF.

Perspective:

Recurrence of AF following catheter ablation is common. In this retrospective analysis, the authors draw attention to the limitation of stroke risk stratification scores in predicting AF recurrence. Given the poor predictive value of these scores, it is important to consider other clinically relevant markers (e.g., type of AF and LA diameter) into rhythm outcome scoring systems.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Stroke, Recurrence, ROC Curve, Catheter Ablation


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