Cardiology Clinic, Clinical Center of Serbia, Višegradska 26, Belgrade, Serbia.
School of Medicine, University of Belgrade, Dr Subotića 8, Belgrade, Serbia.
Sci Rep. 2017 Jan 20;7:40828. doi: 10.1038/srep40828.
Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), 20 patients expirienced a VLRAF during a 29.1 ± 10.1-month follow-up, with a 3-year cumulative VLRAF rate of 31.1%. The MB-LATER score (Male, Bundle brunch block, Left atrium ≥47 mm, Type of AF [paroxysmal, persistent or long-standing persistent], and ER-AF = early recurrent AF), had better predictive ability for VLRAF (AUC 0.782) than the APPLE, ALARMc, BASE-AF2, CHADS, CHADSVASc or HATCH score (AUC 0.716, 0.671, 0.648, 0.552, 0.519 and 0.583, respectively), resulted in an improved net reclassification index (NRI) of 48.6-95.1% and better identified patients with subsequent VLRAF using decision-curve analysis (DCA). The MB-LATER score provides a readily available VLRAF risk assessment, and performs better than other scores. Validation of the MB-LATER score in other cohorts is underway.
可靠预测导管消融（CA）后 12 个月以上的心房颤动（AF）极晚复发（VLRAF），可优化长期随访，并修改关于停止口服抗凝治疗的决策。在一项射频 AFCA 后连续患者的单中心队列中，我们回顾性地为 VLRAF 预测制定了一种新的评分。在 133 例连续 AFCA 后无心律失常的患者中（平均年龄 56.9±11.8 岁，63.9%为男性，69.2%为阵发性 AF），在 12 个月时（不包括 3 个月的“空白期”），20 例患者在 29.1±10.1 个月的随访中发生 VLRAF，3 年的累积 VLRAF 率为 31.1%。MB-LATER 评分（男性、束支阻滞、左心房≥47mm、AF 类型[阵发性、持续性或长程持续性]和 ER-AF=早期复发性 AF）对 VLRAF 的预测能力优于 APPLE、ALARMc、BASE-AF2、CHADS、CHADSVASc 或 HATCH 评分（AUC 为 0.716、0.671、0.648、0.552、0.519 和 0.583），导致净重新分类指数（NRI）改善 48.6-95.1%，并通过决策曲线分析（DCA）更好地识别出随后发生 VLRAF 的患者。MB-LATER 评分提供了一种易于获得的 VLRAF 风险评估，其性能优于其他评分。MB-LATER 评分在其他队列中的验证正在进行中。
