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Relationship Between the CHADS2 Score and Risk of Very Late Recurrences After Catheter Ablation of Paroxysmal Atrial Fibrillation
Study Questions:
Is the CHADS2 score predictive of late arrhythmia recurrences after radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation (AF)?
Methods:
This was a retrospective study of 238 patients (mean age 53 years) who underwent RFCA of paroxysmal AF. Pulmonary vein (PV) isolation was achieved by circumferential ablation around the PVs. Linear ablation was performed in 23% of patients and non-PV triggers were ablated in 12%. A 24-hour Holter monitor or 1-week event monitor was performed every 3 months during follow-up.
Results:
The CHADS2 score was 0 in 45.4% of patients, 1-2 in 42%, and 3-6 in 12.6%. During a median follow-up of 60 months, 51% of patients had a recurrence of an atrial tachyarrhythmia (AT). The recurrence rate at 1 year was 34%. The independent predictors of recurrent AT were left atrial diameter (hazard ratio [HR], 1.04 per millimeter) and CHADS2 score (HR, 1.3). The CHADS2 score was predictive of recurrent AT >2 years post-ablation. Only 1% of patients with a CHADS2 score of 0 had recurrent AT >2 years post-ablation. In patients with a CHADS2 score of 3-6 who were free of AT during the first 2 years of follow-up, 64% subsequently had recurrent AT.
Conclusions:
The CHADS2 score is predictive of outcome after RFCA of AF. A high CHADS2 score is associated with a greater risk of a late recurrence of AT.
Perspective:
As would be expected, the results indicate that patients with multiple comorbidities have a higher risk of recurrent AT late after RFCA of AF. This strengthens the case for maintaining anticoagulation long-term in patients with a high CHADS2 score.
Keywords: Blood Coagulation, Recurrence, Follow-Up Studies, Pulmonary Veins, Atrial Fibrillation, Electrocardiography, Heart Rate, Catheter Ablation, Tachycardia
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