Otsuka Takayuki, Suzuki Shinya, Arita Takuto, Yagi Naoharu, Ikeda Takanori, Yamashita Takeshi
Department of Cardiovascular Medicine The Cardiovascular Institute Tokyo Japan.
Department of Cardiovascular Medicine Toho University Graduate School of Medicine Tokyo Japan.
J Arrhythm. 2020 Sep 2;36(6):997-1006. doi: 10.1002/joa3.12429. eCollection 2020 Dec.
A scoring system to determine indications for catheter ablation (CA) in atrial fibrillation (AF) is desired.
Among 2898 consecutive patients with AF, CA was performed in 938 (32.4%). A new HEAL-AF score has been developed by six variables, all of which were independently associated with CA by multivariate analysis and for each 1 point was assigned: heart failure ≥ NYHA II, elderly patients (age ≥75 years), asymptomatic AF, long-standing persistent AF, atrial dilation (left atrial diameter ≥ 50 mm), and female sex. Low HEAL-AF score was associated with high incidence of CA performance (52.0% for 0, 36.5% for 1, 15.1% for 2, and 5.6% for ≥ 3) and the predictive capability of this score by AUC of ROC curve was 0.720 (95% CI 0.701-0.739, < .001). The rates of freedom from AF/AT recurrence were 73.2% in HEAL-AF score 0, 71.0% in 1, 60.0% in 2, and 50.0% in ≥ 3 (log-rank test, = .004). HEAL-AF score 2 and ≥ 3 were significantly associated with recurrence of atrial tachyarrhythmia as compared with HEAL-AF 0 (HR 1.755, = .002, and HR 2.211, = .007, respectively).
A new HEAL-AF score was associated with patient indication for and the recurrence of atrial tachyarrhythmia after CA in patients with AF. Prescription of CA should be considered carefully in AF patients with HEAL-AF score of 2 and ≥ 3.
需要一种评分系统来确定房颤（AF）患者导管消融（CA）的适应症。
在2898例连续性房颤患者中，938例（32.4%）接受了CA治疗。通过六个变量制定了一种新的HEAL-AF评分，所有这些变量经多因素分析均与CA独立相关，每个变量得1分：心力衰竭≥纽约心脏病协会（NYHA）II级、老年患者（年龄≥75岁）、无症状房颤、长期持续性房颤、心房扩大（左心房直径≥50mm）和女性。低HEAL-AF评分与高CA治疗发生率相关（0分者为52.0%，1分者为36.5%，2分者为15.1%，≥3分者为5.6%），该评分通过ROC曲线下面积（AUC）的预测能力为0.720（95%可信区间0.701-0.739，P<0.001）。HEAL-AF评分为0分时房颤/房性心动过速（AT）复发的自由度为73.2%，1分时为71.0%，2分时为60.0%，≥3分时为50.0%（对数秩检验，P=0.004）。与HEAL-AF 0分相比，HEAL-AF 2分和≥3分与房性快速心律失常复发显著相关（分别为HR 1.755，P=0.002，和HR 2.211，P=0.007）。
新的HEAL-AF评分与房颤患者CA治疗的患者适应症及房性快速心律失常复发相关。对于HEAL-AF评分为2分和≥3分的房颤患者，应谨慎考虑CA治疗的处方。
