C₂HEST and CHA₂DS₂-Vasc for predicting recurrence after catheter ablation of paroxysmal atrial fibrillation

Abstract

Aim    The C2HEST score was developed mainly for predicting atrial fibrillation (AF) in cryptogenic stroke. This study investigated the performance of the C2HEST score in predicting AF recurrence after radiofrequency catheter ablation (RFCA).Material and Methods    189 patients with paroxysmal AF were included in the study. AF recurrence and AF-free survival during follow-up was analyzed. The Cox proportional-hazards model was used to identify independent predictors of AF recurrence after RFCA. Receiver operating characteristic curve analysis and the Hanley and McNeil method were performed to evaluate the performances of the C2HEST and CHA2DS2-VASc scores in predicting AF. AF-free periods of the with C2HEST<2 and C2HEST >2 were compared using Kaplan-Mayer analysis and a log-rank test.Results    The AF recurrence rate within 3–12 months after RFCA was 17.5%. C2HEST score >2, hypertension, left atrial (LA) diameter, and LA volume were independent predictors for AF recurrence (p<0.05). The C2HEST score had better discriminatory performance in predicting AF recurrence than CHA2DS2-VASc (area under curve: 0.769 vs 0.644; p=0.021). The patients with a C2HEST score >2 had a significantly shorter AF-free period compared those with a C2HEST SCORE <2 (p<0.001).Conclusion    In patients who underwent a RFCA procedure due paroxysmal AF, LA diameter and volume and the C2HEST score were independent predictors of AF recurrence. C2HEST is a simple clinical score, and it can be the readily performed to identify the risk of AF recurrence. The C2HEST score has greater diagnostic power than the CHA2DS2-VASc score.