4S-AF方案在预测射频导管消融术后房颤复发中的临床应用价值
Clinical Utility of the 4S-AF Scheme in Predicting Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation.
作者信息
Cui Naiyuan, Li Haiwei, Sun Weiping, Wang Zefeng, Yuan Zhongyu, Zhu Botao, Liu Yutong, Liu Huanfu, Wu Yongquan, Zhang Xiaoping
机构信息
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, 100029 Beijing, China.
The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 100029 Beijing, China.
出版信息
Rev Cardiovasc Med. 2025 Mar 14;26(3):26318. doi: 10.31083/RCM26318. eCollection 2025 Mar.
BACKGROUND
The 4S-AF scheme, which comprises four domains related to atrial fibrillation (AF), stroke risk (St), symptom severity (Sy), severity of AF burden (Sb), and substrate (Su), represents a novel approach for structurally characterizing AF. This study aimed to assess the clinical utility of the scheme in predicting AF recurrence following radiofrequency catheter ablation (RFCA).
METHODS
We prospectively enrolled 345 consecutive patients with AF who underwent initial RFCA between January 2019 and December 2019. The 4S-AF scheme score was calculated and used to characterize AF. The primary outcome assessed was AF recurrence after RFCA, defined as any documented atrial tachyarrhythmia episode lasting at least 30 seconds.
RESULTS
In total, 345 patients (age 61 (interquartile range (IQR): 53-68) years, 34.2% female, 70.7% paroxysmal AF) were analyzed. The median duration of AF history was 12 (IQR: 3-36) months, and the median number of comorbidities was 2 (IQR: 1-3), and 157 (45.5%) patients had left atrial enlargement. During a median follow-up period of 28 (IQR: 13-37) months, AF recurrence occurred in 34.4% of patients. After eliminating the Sy and St domains, both the 4S-AF scheme (hazard ratio (HR) 1.38, 95% confidence interval (CI): 1.19-1.59, < 0.001) and severity of burden and substrate of atrial fibrillation (2S-AF) scheme scores (HR 1.59, 95% CI: 1.33-1.89, < 0.001) were independent predictors of AF recurrence following RFCA. For each domain, we found that the independent predictors were Sb (HR 1.84, 95% CI: 1.25-2.72, = 0.002) and Su (HR 1.71, 95% CI: 1.36-2.14, < 0.001). Furthermore, the 4S-AF (area under the curve (AUC) 65.2%, 95% CI: 59.3-71.1) and 2S-AF scheme score (AUC 66.2%, 95% CI: 60.2-72.1) had a modest ability to predict AF recurrence after RFCA.
CONCLUSIONS
The novel 4S-AF scheme is feasible for evaluating and characterizing AF patients who undergo RFCA. A higher 4S-AF scheme score is independently associated with AF recurrence after RFCA. However, the ability of the 4S-AF scheme to discriminate between patients at high risk of recurrence was limited.
背景
4S-AF方案包含与心房颤动（AF）相关的四个领域，即卒中风险（St）、症状严重程度（Sy）、房颤负荷严重程度（Sb）和基质（Su），是一种对房颤进行结构特征化的新方法。本研究旨在评估该方案在预测射频导管消融（RFCA）后房颤复发方面的临床实用性。
方法
我们前瞻性纳入了2019年1月至2019年12月期间连续接受初次RFCA的345例房颤患者。计算4S-AF方案评分并用于房颤特征化。评估的主要结局是RFCA后房颤复发，定义为任何记录到的持续至少30秒的房性快速性心律失常发作。
结果
共分析了345例患者（年龄61岁（四分位间距（IQR）：53 - 68岁），女性占34.2%，阵发性房颤占70.7%）。房颤病史的中位时长为12个月（IQR：3 - 36个月），合并症的中位数量为2种（IQR：1 - 3种），157例（45.5%）患者有左心房扩大。在中位随访期28个月（IQR：13 - 37个月）内，34.4%的患者发生房颤复发。在排除Sy和St领域后，4S-AF方案（风险比（HR）1.38，95%置信区间（CI）：1.19 - 1.59，P < 0.001）和房颤负荷与基质严重程度（2S-AF）方案评分（HR 1.59，95% CI：1.33 - 1.89，P < 0.001）均为RFCA后房颤复发的独立预测因素。对于每个领域，我们发现独立预测因素为Sb（HR 1.84，95% CI：1.25 - 2.72，P = 0.002）和Su（HR 1.71，95% CI：1.36 - 2.14，P < 0.001）。此外，4S-AF（曲线下面积（AUC）65.2%，95% CI：59.3 - 71.1）和2S-AF方案评分（AUC 66.2%，95% CI：60.2 - 72.1）在预测RFCA后房颤复发方面能力中等。
结论
新型4S-AF方案对于评估和特征化接受RFCA的房颤患者是可行的。较高的4S-AF方案评分与RFCA后房颤复发独立相关。然而，4S-AF方案区分复发高风险患者的能力有限。
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