Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems
Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems
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DOI：
10.1111/pace.13805
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发表时间：
2019-10-18
影响因子：
1.8
通讯作者：
Piccini, Jonathan P.
中科院分区：
文献类型：
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作者：
Black-Maier, Eric;Parish, Alice;Piccini, Jonathan P.
背景与药物治疗相比，心力衰竭(HF)患者的心房颤动(AF)导管消融可改善心血管预后。风险评分(CAAP-AF和APPLE)已经被用来预测消融后房颤复发的可能性，但尚未在房颤和心力衰竭患者中得到特别验证。方法我们分析了2009-2013年在Duke中心房颤登记中心接受PVI治疗的230例房颤和心力衰竭患者消融后12个月的基线特征、风险评分和房颤复发率。结果经过12个月的随访，230例心衰患者中有76例(33%)消融后房颤复发。APPLE和CAAP-AF评分的中位数分别为1.5([Q1，Q3]：[1.0，2.0])和4.0([Q1，Q3]：[3.0，5.0])，与房颤复发组和无房颤复发组比较，差异均无统计学意义。根据APPLE和CAAP-AF评分，脱离房颤的程度没有差别。CAAP-AF评分对复发房颤的鉴别作用不大，C-统计量为0.60(95%CI为0.52~0.67)。对Apple评分的歧视也同样温和，C-统计量为0.54(95%CI：0.47-0.62)。结论经验证的导管消融后房颤复发的预测风险评分在房颤和心力衰竭队列中的预测能力有限。对于伴有心力衰竭的患者，需要更多的工具来促进房颤消融的风险分层和患者选择。
Background Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP-AF and APPLE) have been developed to predict the likelihood of AF recurrence after ablation, have not been validated specifically in patients with AF and HF. Methods We analyzed baseline characteristics, risk scores, and rates of AF recurrence 12 months postablation in a cohort of 230 consecutive patients with AF and HF undergoing PVI in the Duke Center for Atrial Fibrillation registry from 2009-2013. Results During a follow-up period of 12 months, 76 of 230 (33%) patients with HF experienced recurrent AF after ablation. The median APPLE and CAAP-AF scores were 1.5 ([Q1, Q3]: [1.0, 2.0]) and 4.0 ([Q1, Q3]: [3.0, 5.0]), respectively and were not different from those patients with and without recurrent AF. Freedom from AF was not different according to APPLE and CAAP-AF scores. Discrimination for recurrent AF with the CAAP-AF score was modest with a C-statistic of 0.60 (95% CI 0.52-0.67). Discrimination with the APPLE score was similarly modest, with a C-statistic of 0.54 (95% CI: 0.47-0.62). Conclusions Validated predictive risk scores for recurrent AF after catheter ablation exhibit limited predictive ability in cohorts of AF and HF. Additional tools are needed to facilitate risk stratification and patient selection for AF ablation in patients with concomitant HF.