Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Brawijaya, Universitas Brawijaya Hospital, Malang, Indonesia.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan.
Pacing Clin Electrophysiol. 2024 Mar;47(3):462-473. doi: 10.1111/pace.14922. Epub 2024 Feb 24.
Atrial fibrillation (AF) recurrence rates in 1 year after cryoballoon ablation catheter (CBCA) are still high. We purposed to identify strong predictors for AF recurrence after the successful CBCA procedure and develop a new scoring system based only on pre-procedural parameters.
In the derivation phase, a systematic review and meta-analysis identified the strong predictors of AF recurrence after the CBCA. The pooled hazard ratio (HR) was used to create the new scoring system. The second phase validated the new scoring system in the cohort population.
A meta-analysis including 29 cohort studies with 16196 participants confirmed that persistent AF, stroke, heart failure, and left atrial diameter (LAD) >40 mm were powerful predictors for AF recurrence after the CBCA procedure. The HeLPS-Cryo (heart failure [1], left atrial dilatation [1], persistent AF [2], and stroke [2]) was developed based on those pre-procedural predictors. It was validated in 140 patients receiving CBCA procedures and revealed excellent predictive performance for 1-year AF recurrence (AUC = 0.8877; 95% CI = 0.8208 to 0.9546). The HeLPS-Cryo score of ≥3 could predict 1-year AF recurrence with sensitivity and specificity of 78.9% and 87.9%, respectively. The positive predictive value was 66.7%, and the negative predictive value was 93.1%.
The HeLPS-Cryo score can help the physician estimate the probability of 1-year AF recurrence after the successful CBCA procedure. Patients with HeLPS-Cryo score <3 are good candidates for the CBCA procedure.
冷冻球囊导管消融（CBCA）后 1 年内心房颤动（AF）的复发率仍然很高。我们旨在确定 CBCA 成功后 AF 复发的强预测因素，并开发一种仅基于术前参数的新评分系统。
在推导阶段，系统回顾和荟萃分析确定了 CBCA 后 AF 复发的强预测因素。使用合并危险比（HR）创建新的评分系统。第二阶段在队列人群中验证了新的评分系统。
一项纳入 29 项队列研究、共 16196 名参与者的荟萃分析证实，持续性房颤、卒中、心力衰竭和左心房直径（LAD）>40mm 是 CBCA 后 AF 复发的强有力预测因素。基于这些术前预测因素，开发了 HeLPS-Cryo（心力衰竭[1]、左心房扩张[1]、持续性房颤[2]和卒中[2]）。在接受 CBCA 治疗的 140 名患者中进行验证，结果显示该评分对 1 年 AF 复发具有出色的预测性能（AUC=0.8877；95%CI=0.8208 至 0.9546）。HeLPS-Cryo 评分≥3 可预测 1 年 AF 复发，灵敏度和特异性分别为 78.9%和 87.9%。阳性预测值为 66.7%，阴性预测值为 93.1%。
HeLPS-Cryo 评分可帮助医生评估 CBCA 成功后 1 年内 AF 复发的概率。HeLPS-Cryo 评分<3 的患者是 CBCA 治疗的良好候选者。
