Winkle Roger A, Jarman Julian W E, Mead R Hardwin, Engel Gregory, Kong Melissa H, Fleming William, Patrawala Rob A
Silicon Valley Cardiology, E. Palo Alto, California; Sequoia Hospital, Redwood City, California.
Royal Brompton Hospital, London, United Kingdom.
Heart Rhythm. 2016 Nov;13(11):2119-2125. doi: 10.1016/j.hrthm.2016.07.018. Epub 2016 Jul 17.
Patients with a variety of clinical presentations undergo atrial fibrillation (AF) ablation. Long-term ablation success rates can vary considerably.
The purpose of this study was to develop a clinical scoring system to predict long-term freedom from AF after ablation.
We retrospectively derived the scoring system on a development cohort (DC) of 1125 patients undergoing AF ablation and tested it prospectively in a test cohort (TC) of 937 patients undergoing AF ablation.
The demographics of the DC patients were as follows: age 62.3 ± 10.3 years, male sex 801 (71.2%), left atrial size 4.30 ± 0.69 cm, paroxysmal AF 348 (30.9%), number of drugs failed 1.3 ± 1.1, hypertension 525 (46.7%), diabetes 100 (8.9%), prior stroke/transient ischemic attack 78 (6.9%), prior cardioversion 528 (46.9%), and CHADS2 score 0.87 ± 0.97. Multivariate analysis showed 6 independent variables predicting freedom from AF after final ablation: coronary artery disease (P = .021), atrial diameter (P = .0003), age (P = .004), persistent or long-standing AF (P < .0001), number of antiarrhythmic drugs failed (P < .0001), and female sex (P = .0001). We created a scoring system (CAAP-AF) using these 6 variables, with scores ranging from 0 to 13 points. The 2-year AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 95.7%, 2 = 96.3%, 3 = 83.1%, 4 = 85.5%, 5 = 79.9%, 6 = 76.1%, 7 = 63.4%, 8 = 51.1%, 9 = 53.6%, and ≥10 = 29.1%. Ablation success decreased as CAAP-AF scores increased (P < .0001). The CAAP-AF score also predicted freedom from AF in the TC. The 2-year Kaplan-Meier AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 87.0%, 2 = 89.0%, 3 = 91.6%, 4 = 90.5%, 5 = 84.4%, 6 = 70.1%, 7 = 71.0%, 8 = 60.7%, 9 = 68.9%, and ≥10 = 51.3%. As CAAP-AF scores increased, 2-year freedom from AF in the TC decreased (P < .0001).
An easily determined clinical scoring system was derived retrospectively and applied prospectively. The CAAP-AF score predicted freedom from AF after ablation in both a DC and a TC of patients undergoing AF ablation. The CAAP-AF score provides a realistic AF ablation outcome expectation for individual patients.
各种临床表现的患者均接受房颤（AF）消融治疗。长期消融成功率可能有很大差异。
本研究的目的是开发一种临床评分系统，以预测消融术后房颤的长期缓解情况。
我们在1125例接受房颤消融治疗的患者组成的开发队列（DC）中回顾性推导评分系统，并在937例接受房颤消融治疗的患者组成的测试队列（TC）中进行前瞻性测试。
DC患者的人口统计学特征如下：年龄62.3±10.3岁，男性801例（71.2%），左心房大小4.30±0.69cm，阵发性房颤348例（30.9%），失败的抗心律失常药物数量1.3±1.1，高血压525例（46.7%），糖尿病100例（8.9%），既往中风/短暂性脑缺血发作78例（6.9%），既往心脏复律528例（46.9%），CHADS2评分0.87±0.97。多变量分析显示6个独立变量可预测最终消融术后房颤的缓解情况：冠状动脉疾病（P = 0 . .021）、心房直径（P = 0 . .0003）、年龄（P = 0 . .004）、持续性或长期房颤（P < 0 . .0001）、失败的抗心律失常药物数量（P < 0 . .0001）以及女性（P = 0 . .0001）。我们使用这6个变量创建了一个评分系统（CAAP - AF），评分范围为0至13分。CAAP - AF评分对应的2年无房颤率如下：0分 = 100%，1分 = 95.7%，2分 = 96.3%，3分 = 83.1%，4分 = 85.5%，5分 = 79.9%，6分 = 76.1%，7分 = 63.4%，8分 = 51.1%，9分 = 53.6%，≥10分 = 29.1%。随着CAAP - AF评分增加，消融成功率降低（P < 0 . .0001）。CAAP - AF评分在TC中也可预测房颤的缓解情况。CAAP - AF评分对应的2年Kaplan - Meier无房颤率如下：0分 = 100%，1分 = 87.0%，2分 = 89.0%，3分 = 91.6%，4分 = 90.5%，5分 = 84.4%，6分 = 70.1%，7分 = 71.0%，8分 = 60.7%，9分 = 68.9%，≥10分 = 51.3%。随着CAAP - AF评分增加，TC中2年无房颤率降低（P < 0 . .0001）。
回顾性推导并前瞻性应用了一种易于确定的临床评分系统。CAAP - AF评分在接受房颤消融治疗的患者的DC和TC中均能预测消融术后房颤的缓解情况。CAAP - AF评分为个体患者提供了对房颤消融结果的现实预期。
