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CHA2DS2VASc score as a predictor of ablation success defined by continuous long-term monitoring
Graham Lohrmann1, Albert Liu1, Paul Ziegler2
1Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 251 East Huron Street, Room 8-503, Chicago, IL, 60611, USA.
Insights
The CHA2DS2-VASc score predicts atrial fibrillation catheter ablation (AFCA) success when monitored continuously. Scores of 5 or higher indicate a greater risk of AF recurrence after AFCA.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Risk stratification tools for atrial fibrillation catheter ablation (AFCA) success are limited.
- Previous studies often relied on short-term external monitoring for success definition.
- The CHA2DS2-VASc score is a potential predictor of atrial fibrillation (AF) recurrence.
Purpose of the Study:
- To investigate the correlation between the CHA2DS2-VASc score and AFCA success.
- To assess AFCA success using continuous monitoring from cardiac implantable electronic devices (CIEDs).
Main Methods:
- Utilized a de-identified Electronic Health Record dataset linked with the Medtronic CareLink™ database (01/2007-06/2019).
- Included patients undergoing their first AFCA procedure post-CIED implantation.
- Defined success as the absence of at least 1 hour of AF after a 3-month blanking period.
Main Results:
- Analyzed 632 patients (mean age 67 years, 73.3% male) with various CIEDs.
- AFCA success rates at 24 months varied by CHA2DS2-VASc score: 40.3% (0-2), 36.2% (3-4), and 21.8% (≥5).
- Patients with CHA2DS2-VASc scores ≥5 had a higher hazard ratio (1.29) for AF recurrence compared to those with scores 0-2.
Conclusions:
- In real-world patients undergoing AFCA with continuous monitoring, CHA2DS2-VASc scores ≥5 are associated with increased AF recurrence.
- The CHA2DS2-VASc score can aid in stratifying risk for AF recurrence post-ablation.
Background:
There are few reliable risk stratification tools for successful atrial fibrillation catheter ablation (AFCA) and most prior studies have used short-term external monitors to define success. CHA2DS2VASc score may be useful in predicting AF recurrence. We investigated whether CHA2DS2VASc score correlates with AFCA success as measured by continuous monitoring via cardiac implantable electronic devices (CIEDs).
Methods:
Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink™ database, we identified patients who underwent a 1st AFCA procedure following CIED implantation. Success was defined as absence of ≥ 1 h of AF following a 3-month blanking period.
Results:
A total of 632 patients (age 67 ± 9.1 years, 73.3% male, CHA2DS2VASc 3.6 ± 1.8, 36.9% paroxysmal AF) were analyzed and included 35.1% insertable cardiac monitor, 28.8% PPM, 21.4% ICD, 13.6% CRT-D, and 1.1% CRT-P. Success at 24 months post blanking period was 40.3% (95% CI 32.6-49.7%), 36.2% (95% CI 26.9-45.4%), and 21.8% (95% CI 14.6-32.5%) for CHA2DS2VASc subgroups of 0-2, 3-4, and ≥ 5, respectively. Median daily burden of AF was reduced to zero regardless of CHA2DS2VASc score, but there were significant differences in survival free from any AF ≥ 1 h between the three CHA2DS2VASc subgroups (p = 0.013). Patients with a score ≥ 5 had a HR of 1.29 (95% CI 1.00-1.67) for AF recurrence compared to patients with a score of 0-2, with similar results after controlling for AF type.
Conclusions:
In real-world patients with continuous monitoring undergoing AFCA, only CHA2DS2VASc scores ≥ 5 predicted higher AF recurrence.
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