Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany.
University of Leipzig, Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig, Germany.
Europace. 2019 Nov 1;21(11):1646-1652. doi: 10.1093/europace/euz233.
Arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) still remain an important management issue. Recently, the APPLE score had been introduced to predict rhythm outcomes within 12 months after catheter ablation, while the simple MB-LATER score was developed for the prediction of very late recurrence of AF (VLRAF) occurring after 12 months. The aim of this study was to compare APPLE and MB-LATER scores in predicting VLRAF.
The study population included arrhythmia-free patients within first 12 months after first radiofrequency catheter ablation from The Heart Center Leipzig AF Ablation Registry. The APPLE [one point for Age >65 years, Persistent AF, imPaired eGFR <60 mL/min/1.73 m2, Left atrial (LA) diameter ≥43 mm, EF <50%] and MB-LATER scores [one point for Male gender, Bundle branch block or QRS >120 ms, LA diameter ≥47 mm, AF Type (persistent AF), Early Recurrence <3 months] were calculated before and 3 months after ablation, respectively. We followed 482 patients {age 61 [interquartile range (IQR) 54-68] years, 66% males, 32% persistent AF} for median 40 (IQR 35-50) months. There were 184 patients (38.3%) with arrhythmia recurrences within 13-60 months after ablation. On multivariate analysis, APPLE [odds ratio (OR) 1.517, 95% confidence interval (CI) 1.244-1.850, P < 0.001] and MB-LATER (OR 1.437, 95% CI 1.211-1.705, P < 0.001) scores and diabetes mellitus (OR 2.214, 95% CI 1.353-3.625, P = 0.002) were significantly associated with arrhythmia recurrences. Receiver operating characteristic curve analyses demonstrated moderate prediction for both scores [area under the curve (AUC) 0.607, P < 0.001 for APPLE score, AUC 0.604, P < 0.001 for MB-LATER].
Prediction of VLRAF is similar for both APPLE and MB-LATER scores. A better score remains still a clinical unmet need.
心房颤动（AF）导管消融后心律失常复发仍然是一个重要的管理问题。最近，引入了 APPLE 评分来预测导管消融后 12 个月内的节律结果，而简单的 MB-LATER 评分则用于预测 12 个月后发生的 AF 非常晚期复发（VLRAF）。本研究旨在比较 APPLE 和 MB-LATER 评分在预测 VLRAF 中的作用。
研究人群包括来自莱比锡心脏中心 AF 消融登记处首次射频导管消融后 12 个月内无心律失常的患者。APPLE [年龄>65 岁、持续性 AF、eGFR<60ml/min/1.73m2 受损、左心房（LA）直径≥43mm、EF<50%各计 1 分]和 MB-LATER 评分[男性、束支传导阻滞或 QRS>120ms、LA 直径≥47mm、AF 类型（持续性 AF）、早期复发<3 个月各计 1 分]分别在消融前和消融后 3 个月计算。我们随访了 482 例患者[年龄 61[四分位距（IQR）54-68]岁，66%为男性，32%为持续性 AF]，中位随访时间为 40（IQR 35-50）个月。有 184 例（38.3%）患者在消融后 13-60 个月出现心律失常复发。多变量分析显示，APPLE [比值比（OR）1.517，95%置信区间（CI）1.244-1.850，P<0.001]和 MB-LATER（OR 1.437，95%CI 1.211-1.705，P<0.001）评分和糖尿病（OR 2.214，95%CI 1.353-3.625，P=0.002）与心律失常复发显著相关。受试者工作特征曲线分析显示，两种评分均具有中等预测能力[APPLE 评分曲线下面积（AUC）0.607，P<0.001，MB-LATER 评分 AUC 0.604，P<0.001]。
APPLE 和 MB-LATER 评分对 VLRAF 的预测相似。更好的评分仍然是一个临床未满足的需求。
