Scoring systems in the prediction of atrial fibrillation recurrence after surgical ablation

More than every third patient experiences recurrent atrial fibrillation after surgical pulmonary vein ablation. However, it remains challenging to predict who will and who will not experience this event. Scoring systems containing baseline risk factors have been proposed as a complementary tool to identify patients at higher risk of experiencing atrial fibrillation recurrence. Therefore, the aim of this study was to assess the value of the scoring systems APPLE, CHA₂ DS₂ -VASc, and CHADS₂ in predicting atrial fibrillation recurrence following surgical ablation.

In a retrospective study, we identified all patients undergoing concomitant pulmonary vein ablation during cardiac surgery. APPLE-, CHA₂ DS₂ -VASc-, and CHADS₂ scores were calculated for each patient. Subsequently, the predictive value of the scoring systems on atrial fibrillation recurrence 3-12 months postablation was assessed using receiver operating characteristic curves and logistic regression analyses.

Receiver operating characteristic curves showed the superiority of the APPLE scoring system with an area under the curve of 0.690 compared to 0.571 for CHA₂ DS₂ -VASc and 0.569 for CHADS₂ , p = .01. Using logistic regression analyses, APPLE and CHA₂ DS₂ -VASc were predictors of atrial fibrillation recurrence between 3- and 12 months after surgical ablation (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.39-2.67, p < .01 and OR 1.17, 95% CI 1.01-1.36, p = .04, respectively).

The APPLE scoring system is superior to CHA₂ DS₂ -VASc and CHADS₂ in predicting atrial fibrillation recurrence after surgical ablation. It can be used as a complementary tool to select the right candidates for surgical ablation and identify patients who need more frequent clinical and electrocardiogram controls.