- 作者：Roger A. Winkle ; MD ; FHRS* ; &dagger ; ; rawinkle@aol.com" class="auth_mail" title="E-mail the corresponding author ; Julian W.E. Jarman ; MD&Dagger ; ; R. Hardwin Mead ; MD ; FHRS* ; &dagger ; ; Gregory Engel ; MD* ; &dagger ; ; Melissa H. Kong ; MD ; FHRS* ; &dagger ; ; William Fleming ; BS* ; &dagger ; ; Rob A. Patrawala ; MD ; FHRS* ; &dagger ;
- 关键词：Atrial fibrillation ; Atrial fibrillation ablation ; Ablation outcomes ; Catheter ablation ; Radiofrequency ablation
- 刊名：Heart Rhythm
- 出版年：2016
- 出版时间：November 2016
- 年：2016
- 卷：13
- 期：11
- 页码：2119-2125
- 全文大小：1238 K
Objective
The purpose of this study was to develop a clinical scoring system to predict long-term freedom from AF after ablation.
Methods
We retrospectively derived the scoring system on a development cohort (DC) of 1125 patients undergoing AF ablation and tested it prospectively in a test cohort (TC) of 937 patients undergoing AF ablation.
Results
The demographics of the DC patients were as follows: age 62.3 ± 10.3 years, male sex 801 (71.2%), left atrial size 4.30 ± 0.69 cm, paroxysmal AF 348 (30.9%), number of drugs failed 1.3 ± 1.1, hypertension 525 (46.7%), diabetes 100 (8.9%), prior stroke/transient ischemic attack 78 (6.9%), prior cardioversion 528 (46.9%), and CHADS2 score 0.87 ± 0.97. Multivariate analysis showed 6 independent variables predicting freedom from AF after final ablation: coronary artery disease (P = .021), atrial diameter (P = .0003), age (P = .004), persistent or long-standing AF (P < .0001), number of antiarrhythmic drugs failed (P < .0001), and female sex (P = .0001). We created a scoring system (CAAP-AF) using these 6 variables, with scores ranging from 0 to 13 points. The 2-year AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 95.7%, 2 = 96.3%, 3 = 83.1%, 4 = 85.5%, 5 = 79.9%, 6 = 76.1%, 7 = 63.4%, 8 = 51.1%, 9 = 53.6%, and ≥10 = 29.1%. Ablation success decreased as CAAP-AF scores increased (P < .0001). The CAAP-AF score also predicted freedom from AF in the TC. The 2-year Kaplan-Meier AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 87.0%, 2 = 89.0%, 3 = 91.6%, 4 = 90.5%, 5 = 84.4%, 6 = 70.1%, 7 = 71.0%, 8 = 60.7%, 9 = 68.9%, and ≥10 = 51.3%. As CAAP-AF scores increased, 2-year freedom from AF in the TC decreased (P < .0001).
Conclusion
An easily determined clinical scoring system was derived retrospectively and applied prospectively. The CAAP-AF score predicted freedom from AF after ablation in both a DC and a TC of patients undergoing AF ablation. The CAAP-AF score provides a realistic AF ablation outcome expectation for individual patients.