Association of HARMS-AF score with atrial tachyarrhythmia recurrence after radiofrequency catheter ablation: a retrospective observational study.

BACKGROUND AND OBJECTIVE

Atrial fibrillation (AF) is the most common sustained arrhythmia, with high recurrence rates following radiofrequency catheter ablation (RFCA). Identifying predictors of atrial tachyarrhythmia (Ata) recurrence is crucial for risk stratification and personalized management. The HARMS-AF score, a novel lifestyle-based risk score comprising hypertension, age, BMI ≥ 30 kg/m², male sex, sleep apnea, smoking, and alcohol consumption, has emerged as a potential predictor for Ata recurrence. This study aimed to evaluate the association between the HARMS-AF score and Ata recurrence after RFCA.

METHODS

We conducted a retrospective analysis of 152 patients who underwent RFCA at Kunshan Hospital of Traditional Chinese Medicine between January 2021 and December 2022. Ata recurrence was defined as documented episodes of atrial flutter, atrial tachycardia, or AF lasting more than 30 s on ECG or 24-hour Holter monitorin during follow-up. Based on Ata recurrence, patients were classified into recurrence (n = 44) and non-recurrence (n = 108) groups. Clinical characteristics, CHADS-VASc score, and HARMS-AF score were compared between the two groups. Spearman's rank correlation analysis was performed to assess the relationships between the HARMS-AF score, CHADS-VASc score, left atrial diameter (LAD), and Ata recurrence. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of Ata recurrence.

RESULTS

Patients in the recurrence group exhibited a higher prevalence of persistent AF (P = 0.002), larger LAD (P < 0.001), and higher CHADS-VASc (P < 0.001) and HARMS-AF scores (P < 0.001) compared to the non-recurrence group. Spearman's rank correlation analysis revealed significant positive correlations between the HARMS-AF score (r = 0.626, P < 0.001), CHADS-VASc score (r = 0.452, P < 0.001), and LAD (r = 0.405, P < 0.001) with Ata recurrence. Multivariate analysis revealed that LAD (OR = 1.280, 95% CI = 1.118-1.464), CHADS-VASc (OR = 3.773, 95% CI = 1.897-7.503), and HARMS-AF (OR = 3.106, 95% CI = 1.866-5.168) were independent predictors for Ata recurrence after RFCA. The HARMS-AF score demonstrated high sensitivity (93.2%) and specificity (79.6%) for predicting Ata recurrence. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.895 for HARMS-AF, 0.777 for CHADS-VASc, and 0.757 for LAD, with HARMS-AF showing superior predictive accuracy (P = 0.008 vs. CHADS-VASc, P = 0.007 vs. LAD).

CONCLUSION

The HARMS-AF score is significantly associated with Ata recurrence after RFCA and provides a valuable tool for risk prediction. A cut-off value of 7.5 for the HARMS-AF score demonstrates high sensitivity and specificity for predicting Ata recurrence, offering superior prognostic value compared to traditional risk factors. Additionally, Spearman's rank correlation analysis confirms the strong relationship between lifestyle-related factors (as captured by the HARMS-AF score) and Ata recurrence, further supporting the clinical relevance of this score.