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Clinical Utility of the 4S-AF Scheme in Predicting Atrial Fibrillation Recurrence after Radiofrequency Catheter
Naiyuan Cui1, Haiwei Li1, Weiping Sun1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, 100029 Beijing, China.
Insights
The 4S-AF scheme, a new tool for characterizing atrial fibrillation (AF), shows that higher scores predict AF recurrence after radiofrequency catheter ablation (RFCA). However, its ability to identify high-risk patients needs improvement.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Informatics
Background:
- Atrial fibrillation (AF) management benefits from structured characterization.
- The 4S-AF scheme offers a novel framework including AF, stroke risk, symptom severity, AF burden, and substrate.
- Assessing the clinical utility of the 4S-AF scheme in predicting post-ablation recurrence is crucial.
Purpose of the Study:
- To evaluate the clinical utility of the 4S-AF scheme in predicting AF recurrence after radiofrequency catheter ablation (RFCA).
- To determine if the 4S-AF scheme score is an independent predictor of AF recurrence post-RFCA.
Main Methods:
- Prospective enrollment of 345 consecutive AF patients undergoing initial RFCA.
- Calculation of the 4S-AF scheme score for AF characterization.
- Assessment of AF recurrence, defined as any documented atrial tachyarrhythmia lasting ≥30 seconds, during median follow-up of 28 months.
Main Results:
- AF recurrence occurred in 34.4% of patients.
- Higher 4S-AF scheme scores (hazard ratio [HR] 1.38) and 2S-AF (severity of burden and substrate of AF) scores (HR 1.59) were independent predictors of recurrence.
- The severity of AF burden (Sb) and substrate (Su) domains were significant independent predictors (HR 1.84 and HR 1.71, respectively).
- The 4S-AF and 2S-AF schemes demonstrated modest predictive ability (area under the curve [AUC] 65.2% and 66.2%, respectively).
Conclusions:
- The 4S-AF scheme is feasible for evaluating and characterizing AF patients undergoing RFCA.
- A higher 4S-AF scheme score is independently associated with AF recurrence post-RFCA.
- The scheme's ability to discriminate high-risk patients requires further refinement.
Background:
The 4S-AF scheme, which comprises four domains related to atrial fibrillation (AF), stroke risk (St), symptom severity (Sy), severity of AF burden (Sb), and substrate (Su), represents a novel approach for structurally characterizing AF. This study aimed to assess the clinical utility of the scheme in predicting AF recurrence following radiofrequency catheter ablation (RFCA).
Methods:
We prospectively enrolled 345 consecutive patients with AF who underwent initial RFCA between January 2019 and December 2019. The 4S-AF scheme score was calculated and used to characterize AF. The primary outcome assessed was AF recurrence after RFCA, defined as any documented atrial tachyarrhythmia episode lasting at least 30 seconds.
Results:
In total, 345 patients (age 61 (interquartile range (IQR): 53-68) years, 34.2% female, 70.7% paroxysmal AF) were analyzed. The median duration of AF history was 12 (IQR: 3-36) months, and the median number of comorbidities was 2 (IQR: 1-3), and 157 (45.5%) patients had left atrial enlargement. During a median follow-up period of 28 (IQR: 13-37) months, AF recurrence occurred in 34.4% of patients. After eliminating the Sy and St domains, both the 4S-AF scheme (hazard ratio (HR) 1.38, 95% confidence interval (CI): 1.19-1.59, p < 0.001) and severity of burden and substrate of atrial fibrillation (2S-AF) scheme scores (HR 1.59, 95% CI: 1.33-1.89, p < 0.001) were independent predictors of AF recurrence following RFCA. For each domain, we found that the independent predictors were Sb (HR 1.84, 95% CI: 1.25-2.72, p = 0.002) and Su (HR 1.71, 95% CI: 1.36-2.14, p < 0.001). Furthermore, the 4S-AF (area under the curve (AUC) 65.2%, 95% CI: 59.3-71.1) and 2S-AF scheme score (AUC 66.2%, 95% CI: 60.2-72.1) had a modest ability to predict AF recurrence after RFCA.
Conclusions:
The novel 4S-AF scheme is feasible for evaluating and characterizing AF patients who undergo RFCA. A higher 4S-AF scheme score is independently associated with AF recurrence after RFCA. However, the ability of the 4S-AF scheme to discriminate between patients at high risk of recurrence was limited.
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