Association of HARMS₂-AF score with atrial tachyarrhythmia recurrence after radiofrequency catheter ablation: a...

Atrial fibrillation (AF) is the most common sustained arrhythmia, with high recurrence rates following radiofrequency catheter ablation (RFCA). Identifying predictors of atrial tachyarrhythmia (Ata) recurrence is crucial for risk stratification and personalized management. The HARMS₂-AF score, a novel lifestyle-based risk score comprising hypertension, age, BMI ≥ 30 kg/m², male sex, sleep apnea, smoking, and alcohol consumption, has emerged as a potential predictor for Ata recurrence. This study aimed to evaluate the association between the HARMS₂-AF score and Ata recurrence after RFCA.

We conducted a retrospective analysis of 152 patients who underwent RFCA at Kunshan Hospital of Traditional Chinese Medicine between January 2021 and December 2022. Ata recurrence was defined as documented episodes of atrial flutter, atrial tachycardia, or AF lasting more than 30 s on ECG or 24-hour Holter monitorin during follow-up. Based on Ata recurrence, patients were classified into recurrence (n = 44) and non-recurrence (n = 108) groups. Clinical characteristics, CHA₂DS₂-VASc score, and HARMS₂-AF score were compared between the two groups. Spearman's rank correlation analysis was performed to assess the relationships between the HARMS₂-AF score, CHA₂DS₂-VASc score, left atrial diameter (LAD), and Ata recurrence. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of Ata recurrence.

Patients in the recurrence group exhibited a higher prevalence of persistent AF (P = 0.002), larger LAD (P < 0.001), and higher CHA₂DS₂-VASc (P < 0.001) and HARMS₂-AF scores (P < 0.001) compared to the non-recurrence group. Spearman's rank correlation analysis revealed significant positive correlations between the HARMS₂-AF score (r = 0.626, P < 0.001), CHA₂DS₂-VASc score (r = 0.452, P < 0.001), and LAD (r = 0.405, P < 0.001) with Ata recurrence. Multivariate analysis revealed that LAD (OR = 1.280, 95% CI = 1.118-1.464), CHA₂DS₂-VASc (OR = 3.773, 95% CI = 1.897-7.503), and HARMS₂-AF (OR = 3.106, 95% CI = 1.866-5.168) were independent predictors for Ata recurrence after RFCA. The HARMS₂-AF score demonstrated high sensitivity (93.2%) and specificity (79.6%) for predicting Ata recurrence. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.895 for HARMS₂-AF, 0.777 for CHA₂DS₂-VASc, and 0.757 for LAD, with HARMS₂-AF showing superior predictive accuracy (P = 0.008 vs. CHA₂DS₂-VASc, P = 0.007 vs. LAD).

The HARMS₂-AF score is significantly associated with Ata recurrence after RFCA and provides a valuable tool for risk prediction. A cut-off value of 7.5 for the HARMS₂-AF score demonstrates high sensitivity and specificity for predicting Ata recurrence, offering superior prognostic value compared to traditional risk factors. Additionally, Spearman's rank correlation analysis confirms the strong relationship between lifestyle-related factors (as captured by the HARMS₂-AF score) and Ata recurrence, further supporting the clinical relevance of this score.