Comparison of CHADS 2 , R 2 CHADS 2 , and CHA 2 DS 2 -VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation

Abstract

Background— Recurrences of atrial fibrillation (AF) occur in up to 30% within 1 year after catheter ablation. This study evaluated the value of CHADS 2 , R 2 CHADS 2 , and CHA 2 DS 2 -VASc scores for the prediction of rhythm outcomes after AF catheter ablation. Methods and Results— Using the Leipzig Heart Center AF Ablation Registry, we documented rhythm outcomes within the first 12 months in 2069 patients (67% men; 60±10 years; 35% persistent AF) undergoing AF catheter ablation. AF recurrences were defined as any atrial arrhythmia occurring within the first week (early recurrences, ERAF) and between 3 and 12 months (late recurrences, LRAF) after ablation. ERAF and LRAF occurred in 36% and 33%, respectively. On multivariable analysis, R 2 CHADS 2 (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02–1.21; P =0.016) and CHA 2 DS 2 -VASc (OR, 1.09; 95% CI, 1.017–1.17; P =0.015) scores as well as persistent AF and left atrial diameter were significant predictors for ERAF. Similarly, the same clinical variables remained significant predictors for LRAF even after adjustment for ERAF, which was the strongest predictor for LRAF (HR, 3.12; 95% CI, 2.62–3.71; P <0.001). However, using receiver operating characteristic curve analyses, both scores demonstrated relatively low predictive value for ERAF (area under the curve [AUC], 0.536 [0.510–0.563]; P =0.007; and AUC, 0.547 [0.521–0.573]; P <0.001 for R 2 CHADS 2 and CHA 2 DS 2 -VASc, respectively) and LRAF (AUC, 0.548 [0.518–0.578]; P =0.002; and AUC, 0.550 [0.520–0.580]; P =0.001). Conclusions— R 2 CHADS 2 and CHA 2 DS 2 -VASc were associated with rhythm outcomes after catheter ablation. However, AF type, left atrial diameter, and especially ERAF are also significant predictors for LRAF that should be included into new clinical scores for the prediction of rhythm outcomes after catheter ablation.