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Updated: Feb 21, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Development and validation of a risk score for predicting atrial fibrillation recurrence after a first catheter
João Mesquita1, António Miguel Ferreira1,2, Diogo Cavaco1,2
1Cardiology Department, Hospital de Santa Cruz, Av. Prof. Reinaldo dos Santos, Carnaxide, Lisbon, Portugal.
Insights
A new risk score helps predict atrial fibrillation (AF) recurrence after catheter ablation. This tool identifies patients at high risk for AF relapse post-pulmonary vein isolation (PVI).
Area of Science:
- Cardiology
- Electrophysiology
- Medical Informatics
Background:
- Catheter ablation for atrial fibrillation (AF) is common, but predicting relapse remains difficult.
- Existing methods for assessing individual patient risk of AF recurrence post-ablation are insufficient.
Purpose of the Study:
- To develop and validate a novel risk score for estimating AF recurrence after the first radiofrequency pulmonary vein isolation (PVI).
Main Methods:
- A retrospective analysis of 1934 patients undergoing their first PVI was performed.
- A risk score was developed using Cox regression in 50% of patients and validated in the other 50%.
- Predictors included age, sex, AF type, smoking status, and left atrial volume.
Main Results:
- Five independent predictors were identified: age >60, female sex, non-paroxysmal AF, current smoking, and indexed left atrial volume.
- The score demonstrated good discriminative power (c-statistic 0.75) in both development and validation cohorts.
- AF recurrence rates per year were 8% (low-risk), 11% (intermediate-risk), and 17-18% (high-risk).
Conclusions:
- A validated, simple risk score effectively estimates AF recurrence risk after PVI.
- The score can aid in patient selection and risk stratification for AF ablation procedures.
- Further external validation is recommended to assess its utility as a patient selection tool.
Aims:
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.
Methods And Results:
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 (<6 points), intermediate (6-10 points), and high-risk patients (>10 points), respectively (P < 0.001). In the validation group, AF recurrence rates were 8, 11, and 18%/year, respectively (P < 0.001).
Conclusion:
A simple risk score to estimate the rate of AF recurrence after ablation was developed and validated. An external assessment of its usefulness as a patient selection tool seems warranted.
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