Predictive Value of C2HEST Score for Atrial Fibrillation Recurrence Following Successful Cryoballoon Pulmonary Vein
Fatih Levent1, Selçuk Kanat1, Ahmet Tutuncu1
1Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey.
Insights
The C2HEST score effectively predicts atrial fibrillation recurrence after cryoballoon ablation, outperforming the CHA2DS2-VASc score. This simple clinical tool aids risk assessment for patients undergoing AF ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Informatics
Background:
- Atrial fibrillation (AF) recurrence is a concern after cryoballoon ablation (CRYO).
- Predictive scores are crucial for assessing post-ablation outcomes.
- The C2HEST score has shown utility in predicting incidental AF.
Purpose of the Study:
- To evaluate the C2HEST score's performance in predicting AF recurrence post-CRYO for paroxysmal AF.
- To compare the predictive accuracy of the C2HEST score against the CHA2DS2-VASc score in this patient cohort.
Main Methods:
- A study involving 252 patients undergoing CRYO for paroxysmal AF.
- Assessment of AF recurrence rates between 3-12 months post-ablation.
- Comparison of C2HEST and CHA2DS2-VASc scores using area under the curve (AUC) analysis.
Main Results:
- The AF recurrence rate was 20.2% within 3-12 months.
- C2HEST score demonstrated significantly better predictive value (AUC: 0.881) than CHA2DS2-VASc (AUC: 0.741; P = .0017).
- Independent predictors for recurrence included C2HEST score ≥2, increased atrial diameter, elevated E/e' ratio, COPD, and systolic heart failure.
Conclusions:
- The C2HEST score is a valuable tool for assessing AF recurrence risk in patients after CRYO.
- It offers superior prediction compared to the CHA2DS2-VASc score in this context.
- Simple clinical parameters integrated into the C2HEST score aid risk stratification post-ablation.
Abstract:
The C2HEST score ((coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) [C2, 1 point each]; hypertension [H, 1 point]; elderly [E, age ≥75 years, 2 points]; systolic heart failure [S, 2 points]; thyroid disease [T, hyperthyroidism, 1 point]) has been validated for predicting incidental atrial fibrillation (AF) in both the general population and patients with ischemic stroke. The present study evaluated the performance of this score in predicting AF recurrence in 252 patients following cryoballoon ablation (CRYO) for paroxysmal AF. The AF recurrence rate in 3-12 months following CRYO was 20,2%. The predictive value of the C2HEST score was significantly better than that of the CHA2DS2-VASc score ((congestive heart failure, hypertension, age (>65 = 1 point, >75 = 2 points), diabetes, previous stroke/transient ischemic attack (2 points), vascular disease, age 65-74 years, and sex category)) (area under curve [AUC]: .881 vs .741; P = .0017). C2HEST score of ≥2, increased atrial diameter, and E/e' ratio as well as, the presence of COPD and systolic heart failure (SHF) were independent predictors for AF recurrence (P < .05). In patients undergoing CRYO for paroxysmal AF, the C2HEST, a simple clinical score, could be useful to assess the risk of AF recurrence.
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