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New Score for Predicting Results after Catheter Ablation for Atrial Fibrillation: VAT-DHF
Alexandrina Nastasă1, Ștefan Bogdan1,2, Corneliu Iorgulescu3
1Cardiology Departament, Elias Universitary Emergency Hospital, 011461 Bucharest, Romania.
Insights
A new VAT-DHF score effectively predicts atrial fibrillation recurrence after catheter ablation. This tool helps stratify patients into low, intermediate, or high-risk categories for better post-ablation management.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Informatics
Background:
- Catheter ablation (CA) is highly effective for maintaining sinus rhythm in atrial fibrillation (AF).
- Existing predictive scores for CA success lack prospective validation.
- Optimal formulae for predicting post-procedural outcomes require further research.
Purpose of the Study:
- To identify independent predictors of AF recurrence following CA.
- To develop a novel composite score for predicting AF recurrence after CA.
Main Methods:
- Retrospective analysis of consecutive patients undergoing CA for persistent and paroxysmal AF.
- Development of a predictive scoring model based on identified independent predictors.
Main Results:
- The VAT-DHF score, incorporating AF type, left atrium volume, diabetes, height, and f-wave amplitude, demonstrated superior predictive accuracy (AUC=0.869) compared to APPLE and CHA2DS2-VASc scores.
- Predictors of recurrence included persistent AF, low f-waves (<0.1 mV), increased indexed left atrium volume, type 2 diabetes, and smaller height.
- Success rates varied significantly with VAT-DHF score: 95.7% for scores 0-3.25, 76.3% for 3.25-6, and 25% for scores ≥6 (p < 0.0001).
Conclusions:
- The novel VAT-DHF score is a simple and effective tool for risk stratification of AF recurrence post-CA.
- This score can assist clinicians in identifying patients at low, intermediate, or high risk, guiding clinical management decisions.
Introduction:
Catheter ablation (CA) for atrial fibrillation (AF) has been proven to have the highest efficacy in maintaining sinus rhythm. Several studies have proposed different scores for predicting post-procedural success, but most have not been validated in prospective cohorts. Further research is required to determine the optimal formulae.
Purpose:
This study aimed to identify independent predictors of AF recurrence after CA and develop a composite score.
Methods:
Consecutive patients with persistent and paroxysmal AF who underwent CA were retrospectively analyzed. The independent predictors of recurrence were used to create a new predictive score.
Results:
The cohort included 263 patients with a follow-up of 37.6 ± 23.4 months. Persistent AF, f-waves < 0.1 mV, indexed left atrium volume, the presence of type 2 diabetes, and smaller height were independent predictors of recurrence and were used to create a new scoring model, VAT-DHF (V = Volume, AT = AF Type, D = Diabetes, H = Height, F = f waves). The ROC curve for this new score showed an AUC of 0.869, p < 0.0001, 95% CI [0.802-0.936], while those for APPLE and CHA2DS2-VASc showed an AUC of 0.765, 95% CI [0.637-0.893] and an AUC of 0.655, 95% CI [0.580-0.730], respectively. Patients who had a VAT-DHF score between 0 and 3.25, 3.25 and 6, and ≥6, had success rates of 95.7%, 76.3%, and 25% (p < 0.0001), respectively.
Conclusions:
The novel VAT-DHF score is easy to calculate and may be a useful clinical tool for identifying patients with a low, intermediate, or high risk of AF recurrence after CA.
