Development and validation of a risk score for predicting atrial fibrillation recurrence after a first catheter ablation procedure - ATLAS score

• Published in: Europace (London, England) England), 2018-11, Vol.20 (FI_3), p.f428-f435
• Main Authors: Mesquita, João, Ferreira, António Miguel, Cavaco, Diogo, Moscoso Costa, Francisco, Carmo, Pedro, Marques, Hugo, Morgado, Francisco, Mendes, Miguel, Adragão, Pedro
• Format: Article
• Language: English
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eux265

Several predictors of relapse after catheter ablation of atrial fibrillation (AF) have been established, but assessing each patient's individual risk remains challenging. Our aim was to develop and validate a score to estimate the risk of AF recurrence after the first radiofrequency pulmonary vein isolation (PVI) procedure. Independent predictors of AF relapse were identified retrospectively in a two-centre registry of 1934 patients who underwent a first PVI procedure. Using the Cox regression hazard ratios of designated variables, a risk score was developed in a random sample of 50% of the patients (development cohort) and validated in the remaining (validation cohort) half. The accuracy and discriminative power of the predictive model were assessed in both subgroups. During a follow-up of 4.2 ± 2.7 years, 522 patients (27%) relapsed. Five independent predictors of AF recurrence were identified and included in the score: age >60 years (1 point), female sex (4 points), non-paroxysmal AF (2 points), current smoking (7 points) and indexed left atrial volume (1 point for each 10 mL/m2). The score showed good discriminative power (censored c-statistic of 0.75 in both cohorts). In the development group, AF relapse rates were 8, 11, and 17%/year for low (10 points), respectively (P