A Simple Score to Predict New-Onset Atrial Fibrillation After Ablation of Typical Atrial Flutter

Area of Science:

• Cardiology
• Electrophysiology
• Medical Informatics

Background:

• New-onset atrial fibrillation (NeAF) frequently occurs post-cavotricuspid isthmus-dependent counterclockwise atrial flutter (CCW-AFL) ablation.
• A simple predictive model for NeAF post-ablation is needed.

Purpose of the Study:

• To develop and validate a simple predictive model for NeAF after CCW-AFL ablation.
• To identify key clinical, echocardiographic, and electrocardiographic predictors of NeAF.

Main Methods:

• A derivation cohort (190 patients) and a validation cohort (81 patients) were established from data collected between 2013-2017.
• Logistic regression identified predictors, leading to the development of the HAD-AF score.
• The score's predictive performance was compared against CHA2DS2-VASc and HATCH scores.

Main Results:

• During a mean follow-up of 73 months, 39.5% of 271 patients developed NeAF.
• Key predictors included hypertension, age ≥ 70, left atrial diameter ≥ 42 mm, P-wave duration ≥ 120 ms, and negative flutter wave in lead II ≥ 120 ms.
• The HAD-AF score demonstrated superior predictive accuracy (AUC 0.938) compared to CHA2DS2-VASc and HATCH scores in both cohorts.

Conclusions:

• The HAD-AF score reliably identifies patients at risk for developing NeAF after CCW-AFL ablation.
• This score offers a valuable tool for risk stratification and personalized patient management post-procedure.