Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Interv Card Electrophysiol. 2023 Nov;66(8):1859-1865. doi: 10.1007/s10840-023-01494-z. Epub 2023 Feb 9.
To date, few risk models have been validated to predict recurrent atrial fibrillation (AF) >1 year after ablation. The SCALE-CryoAF score was previously derived to predict very late return of AF (VLRAF) >1 year following cryoballoon ablation (CBA), with strong predictive ability. In this study, we aim to validate the SCALE-CryoAF score for VLRAF after CBA in a novel patient cohort.
Retrospective analysis of a prospectively maintained single-center database was performed. Inclusion criteria were pulmonary vein isolation using CBA 2017-2020. Exclusion criteria included prior ablation, <1-year follow-up, lack of pre-CBA echocardiogram, additional ablation lesion sets, and documented AF recurrence 90-365 days post-CBA. The area under the curve (AUC) of SCALE-CryoAF was compared to the derivation value and other established risk models.
Among 469 CBA performed, 241 (61% male, 62.8 ±11.7 years old) cases were included in analysis. There were 37 (15.4%) patients who developed VLRAF. Patients with VLRAF had a higher SCALE-CryoAF score (VLRAF 5.4 ± 2.7; no VLRAF 3.1 ± 2.9; p<0.001). SCALE-CryoAF was linearly associated with VLRAF (y=14.35x-11.72, R=0.99), and a score > 5 had a 32.7% risk of VLRAF. The SCALE-CryoAF risk model predicted VLRAF with an AUC of 0.74, which was similar to the derivation value (AUC: 0.73) and statistically superior to MB-LATER, CHA2DS2-VASc, and CHADS scores.
The current analysis validates the ability of SCALE-CryoAF to predict VLRAF after CBA in a novel patient cohort. Patients with a high SCALE-CryoAF score should be monitored closely for recurrent AF >1 year following CBA.
迄今为止，很少有风险模型被验证可预测消融后 1 年以上的复发性心房颤动（AF）。此前，SCALE-CryoAF 评分被用来预测冷冻球囊消融（CBA）后 1 年以上的非常晚期 AF 复发（VLRAF），具有很强的预测能力。在这项研究中，我们旨在验证该评分在新患者队列中预测 CBA 后 VLRAF 的能力。
对前瞻性维护的单中心数据库进行回顾性分析。纳入标准为 2017-2020 年使用 CBA 进行肺静脉隔离。排除标准包括既往消融、随访时间<1 年、术前超声心动图缺失、附加消融线、CBA 后 90-365 天记录到 AF 复发。比较了 SCALE-CryoAF 的曲线下面积（AUC）与原始数据及其他已建立的风险模型。
在 469 例 CBA 中，有 241 例（61%为男性，62.8±11.7 岁）纳入分析。37 例（15.4%）患者发生 VLRAF。发生 VLRAF 的患者 SCALE-CryoAF 评分更高（VLRAF 5.4±2.7；无 VLRAF 3.1±2.9；p<0.001）。SCALE-CryoAF 与 VLRAF 呈线性相关（y=14.35x-11.72，R=0.99），评分>5 时 VLRAF 风险为 32.7%。SCALE-CryoAF 风险模型预测 VLRAF 的 AUC 为 0.74，与原始数据相当（AUC：0.73），且统计学上优于 MB-LATER、CHA2DS2-VASc 和 CHADS 评分。
本分析在新的患者队列中验证了 SCALE-CryoAF 预测 CBA 后 VLRAF 的能力。SCALE-CryoAF 评分高的患者应密切监测 CBA 后 1 年以上的 AF 复发。
