Predicting atrial fibrillation ablation outcome: The CAAP-AF score
Background Patients with a variety of clinical presentations undergo atrial fibrillation (AF) ablation. Long-term ablation success rates can vary considerably. Objective The purpose of this study was to develop a clinical scoring system to predict long-term freedom from AF after ablation. Methods We...
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| creator | Winkle, Roger A., MD, FHRS Jarman, Julian W.E., MD Mead, R. Hardwin, MD, FHRS Engel, Gregory, MD Kong, Melissa H., MD, FHRS Fleming, William, BS Patrawala, Rob A., MD, FHRS |
| description | Background Patients with a variety of clinical presentations undergo atrial fibrillation (AF) ablation. Long-term ablation success rates can vary considerably. Objective The purpose of this study was to develop a clinical scoring system to predict long-term freedom from AF after ablation. Methods We retrospectively derived the scoring system on a development cohort (DC) of 1125 patients undergoing AF ablation and tested it prospectively in a test cohort (TC) of 937 patients undergoing AF ablation. Results The demographics of the DC patients were as follows: age 62.3 ± 10.3 years, male sex 801 (71.2%), left atrial size 4.30 ± 0.69 cm, paroxysmal AF 348 (30.9%), number of drugs failed 1.3 ± 1.1, hypertension 525 (46.7%), diabetes 100 (8.9%), prior stroke/transient ischemic attack 78 (6.9%), prior cardioversion 528 (46.9%), and CHADS2 score 0.87 ± 0.97. Multivariate analysis showed 6 independent variables predicting freedom from AF after final ablation: coronary artery disease (P = .021), atrial diameter (P = .0003), age (P = .004), persistent or long-standing AF (P < .0001), number of antiarrhythmic drugs failed (P < .0001), and female sex (P = .0001). We created a scoring system (CAAP-AF) using these 6 variables, with scores ranging from 0 to 13 points. The 2-year AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 95.7%, 2 = 96.3%, 3 = 83.1%, 4 = 85.5%, 5 = 79.9%, 6 = 76.1%, 7 = 63.4%, 8 = 51.1%, 9 = 53.6%, and ≥10 = 29.1%. Ablation success decreased as CAAP-AF scores increased (P < .0001). The CAAP-AF score also predicted freedom from AF in the TC. The 2-year Kaplan-Meier AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 87.0%, 2 = 89.0%, 3 = 91.6%, 4 = 90.5%, 5 = 84.4%, 6 = 70.1%, 7 = 71.0%, 8 = 60.7%, 9 = 68.9%, and ≥10 = 51.3%. As CAAP-AF scores increased, 2-year freedom from AF in the TC decreased (P < .0001). Conclusion An easily determined clinical scoring system was derived retrospectively and applied prospectively. The CAAP-AF score predicted freedom from AF after ablation in both a DC and a TC of patients undergoing AF ablation. The CAAP-AF score provides a realistic AF ablation outcome expectation for individual patients. |
| doi_str_mv | 10.1016/j.hrthm.2016.07.018 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826727927</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1547527116305483</els_id><sourcerecordid>1826727927</sourcerecordid><originalsourceid>FETCH-LOGICAL-c525t-9dfb41b3e1a7274e999b54a67f4ab44aef42d459772b24e8ee31173d545bb6423</originalsourceid><addsrcrecordid>eNqFkU1r3DAQhkVoySab_IJC8LEXO_q07EID26X5gEADSc5CksddbWwrkexC_n3l7LaHXHKaGXjfeaVnEPpCcEEwKc-3xSaMm76gaSiwLDCpDtAREaLMWSXJp7nnMhdUkgU6jnGLMa1LzA7RgkrOhKjKI_TjLkDj7OiG35keg9Nd1joTXNfp0fkh02bf-Gm0vodv2cMGsvVqdZevLrNofYAT9LnVXYTTfV2ix8ufD-vr_PbX1c16dZtbQcWY101rODEMiJYpH-q6NoLrUrZcG841tJw2XNRSUkM5VACMEMkawYUxJadsib7u9j4H_zJBHFXvooX00gH8FBWpaJk211QmKdtJbfAxBmjVc3C9Dq-KYDXDU1v1Bk_N8BSWKsFLrrN9wGR6aP57_tFKgu87AaRv_nEQVLQOBpsIBrCjarz7IODind92bnBWd0_wCnHrpzAkgoqoSBVW9_P95vORkmHBK8b-AniclLc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1826727927</pqid></control><display><type>article</type><title>Predicting atrial fibrillation ablation outcome: The CAAP-AF score</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Winkle, Roger A., MD, FHRS ; Jarman, Julian W.E., MD ; Mead, R. Hardwin, MD, FHRS ; Engel, Gregory, MD ; Kong, Melissa H., MD, FHRS ; Fleming, William, BS ; Patrawala, Rob A., MD, FHRS</creator><creatorcontrib>Winkle, Roger A., MD, FHRS ; Jarman, Julian W.E., MD ; Mead, R. Hardwin, MD, FHRS ; Engel, Gregory, MD ; Kong, Melissa H., MD, FHRS ; Fleming, William, BS ; Patrawala, Rob A., MD, FHRS</creatorcontrib><description>Background Patients with a variety of clinical presentations undergo atrial fibrillation (AF) ablation. Long-term ablation success rates can vary considerably. Objective The purpose of this study was to develop a clinical scoring system to predict long-term freedom from AF after ablation. Methods We retrospectively derived the scoring system on a development cohort (DC) of 1125 patients undergoing AF ablation and tested it prospectively in a test cohort (TC) of 937 patients undergoing AF ablation. Results The demographics of the DC patients were as follows: age 62.3 ± 10.3 years, male sex 801 (71.2%), left atrial size 4.30 ± 0.69 cm, paroxysmal AF 348 (30.9%), number of drugs failed 1.3 ± 1.1, hypertension 525 (46.7%), diabetes 100 (8.9%), prior stroke/transient ischemic attack 78 (6.9%), prior cardioversion 528 (46.9%), and CHADS2 score 0.87 ± 0.97. Multivariate analysis showed 6 independent variables predicting freedom from AF after final ablation: coronary artery disease (P = .021), atrial diameter (P = .0003), age (P = .004), persistent or long-standing AF (P < .0001), number of antiarrhythmic drugs failed (P < .0001), and female sex (P = .0001). We created a scoring system (CAAP-AF) using these 6 variables, with scores ranging from 0 to 13 points. The 2-year AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 95.7%, 2 = 96.3%, 3 = 83.1%, 4 = 85.5%, 5 = 79.9%, 6 = 76.1%, 7 = 63.4%, 8 = 51.1%, 9 = 53.6%, and ≥10 = 29.1%. Ablation success decreased as CAAP-AF scores increased (P < .0001). The CAAP-AF score also predicted freedom from AF in the TC. The 2-year Kaplan-Meier AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 87.0%, 2 = 89.0%, 3 = 91.6%, 4 = 90.5%, 5 = 84.4%, 6 = 70.1%, 7 = 71.0%, 8 = 60.7%, 9 = 68.9%, and ≥10 = 51.3%. As CAAP-AF scores increased, 2-year freedom from AF in the TC decreased (P < .0001). Conclusion An easily determined clinical scoring system was derived retrospectively and applied prospectively. The CAAP-AF score predicted freedom from AF after ablation in both a DC and a TC of patients undergoing AF ablation. The CAAP-AF score provides a realistic AF ablation outcome expectation for individual patients.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2016.07.018</identifier><identifier>PMID: 27435586</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Ablation outcomes ; Aged ; Anti-Arrhythmia Agents - therapeutic use ; Atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - epidemiology ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Atrial fibrillation ablation ; Cardiovascular ; Catheter ablation ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Comorbidity ; Female ; Humans ; Long Term Adverse Effects - diagnosis ; Long Term Adverse Effects - etiology ; Long Term Adverse Effects - prevention & control ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Predictive Value of Tests ; Radiofrequency ablation ; Recurrence ; Research Design ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; United Kingdom - epidemiology</subject><ispartof>Heart rhythm, 2016-11, Vol.13 (11), p.2119-2125</ispartof><rights>The Authors</rights><rights>2016 The Authors</rights><rights>Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-9dfb41b3e1a7274e999b54a67f4ab44aef42d459772b24e8ee31173d545bb6423</citedby><cites>FETCH-LOGICAL-c525t-9dfb41b3e1a7274e999b54a67f4ab44aef42d459772b24e8ee31173d545bb6423</cites><orcidid>0000-0001-9481-6913</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527116305483$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27435586$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Winkle, Roger A., MD, FHRS</creatorcontrib><creatorcontrib>Jarman, Julian W.E., MD</creatorcontrib><creatorcontrib>Mead, R. Hardwin, MD, FHRS</creatorcontrib><creatorcontrib>Engel, Gregory, MD</creatorcontrib><creatorcontrib>Kong, Melissa H., MD, FHRS</creatorcontrib><creatorcontrib>Fleming, William, BS</creatorcontrib><creatorcontrib>Patrawala, Rob A., MD, FHRS</creatorcontrib><title>Predicting atrial fibrillation ablation outcome: The CAAP-AF score</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Patients with a variety of clinical presentations undergo atrial fibrillation (AF) ablation. Long-term ablation success rates can vary considerably. Objective The purpose of this study was to develop a clinical scoring system to predict long-term freedom from AF after ablation. Methods We retrospectively derived the scoring system on a development cohort (DC) of 1125 patients undergoing AF ablation and tested it prospectively in a test cohort (TC) of 937 patients undergoing AF ablation. Results The demographics of the DC patients were as follows: age 62.3 ± 10.3 years, male sex 801 (71.2%), left atrial size 4.30 ± 0.69 cm, paroxysmal AF 348 (30.9%), number of drugs failed 1.3 ± 1.1, hypertension 525 (46.7%), diabetes 100 (8.9%), prior stroke/transient ischemic attack 78 (6.9%), prior cardioversion 528 (46.9%), and CHADS2 score 0.87 ± 0.97. Multivariate analysis showed 6 independent variables predicting freedom from AF after final ablation: coronary artery disease (P = .021), atrial diameter (P = .0003), age (P = .004), persistent or long-standing AF (P < .0001), number of antiarrhythmic drugs failed (P < .0001), and female sex (P = .0001). We created a scoring system (CAAP-AF) using these 6 variables, with scores ranging from 0 to 13 points. The 2-year AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 95.7%, 2 = 96.3%, 3 = 83.1%, 4 = 85.5%, 5 = 79.9%, 6 = 76.1%, 7 = 63.4%, 8 = 51.1%, 9 = 53.6%, and ≥10 = 29.1%. Ablation success decreased as CAAP-AF scores increased (P < .0001). The CAAP-AF score also predicted freedom from AF in the TC. The 2-year Kaplan-Meier AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 87.0%, 2 = 89.0%, 3 = 91.6%, 4 = 90.5%, 5 = 84.4%, 6 = 70.1%, 7 = 71.0%, 8 = 60.7%, 9 = 68.9%, and ≥10 = 51.3%. As CAAP-AF scores increased, 2-year freedom from AF in the TC decreased (P < .0001). Conclusion An easily determined clinical scoring system was derived retrospectively and applied prospectively. The CAAP-AF score predicted freedom from AF after ablation in both a DC and a TC of patients undergoing AF ablation. The CAAP-AF score provides a realistic AF ablation outcome expectation for individual patients.</description><subject>Ablation outcomes</subject><subject>Aged</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Atrial fibrillation ablation</subject><subject>Cardiovascular</subject><subject>Catheter ablation</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheter Ablation - methods</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Humans</subject><subject>Long Term Adverse Effects - diagnosis</subject><subject>Long Term Adverse Effects - etiology</subject><subject>Long Term Adverse Effects - prevention & control</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Predictive Value of Tests</subject><subject>Radiofrequency ablation</subject><subject>Recurrence</subject><subject>Research Design</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>United Kingdom - epidemiology</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1r3DAQhkVoySab_IJC8LEXO_q07EID26X5gEADSc5CksddbWwrkexC_n3l7LaHXHKaGXjfeaVnEPpCcEEwKc-3xSaMm76gaSiwLDCpDtAREaLMWSXJp7nnMhdUkgU6jnGLMa1LzA7RgkrOhKjKI_TjLkDj7OiG35keg9Nd1joTXNfp0fkh02bf-Gm0vodv2cMGsvVqdZevLrNofYAT9LnVXYTTfV2ix8ufD-vr_PbX1c16dZtbQcWY101rODEMiJYpH-q6NoLrUrZcG841tJw2XNRSUkM5VACMEMkawYUxJadsib7u9j4H_zJBHFXvooX00gH8FBWpaJk211QmKdtJbfAxBmjVc3C9Dq-KYDXDU1v1Bk_N8BSWKsFLrrN9wGR6aP57_tFKgu87AaRv_nEQVLQOBpsIBrCjarz7IODind92bnBWd0_wCnHrpzAkgoqoSBVW9_P95vORkmHBK8b-AniclLc</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Winkle, Roger A., MD, FHRS</creator><creator>Jarman, Julian W.E., MD</creator><creator>Mead, R. Hardwin, MD, FHRS</creator><creator>Engel, Gregory, MD</creator><creator>Kong, Melissa H., MD, FHRS</creator><creator>Fleming, William, BS</creator><creator>Patrawala, Rob A., MD, FHRS</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9481-6913</orcidid></search><sort><creationdate>20161101</creationdate><title>Predicting atrial fibrillation ablation outcome: The CAAP-AF score</title><author>Winkle, Roger A., MD, FHRS ; Jarman, Julian W.E., MD ; Mead, R. Hardwin, MD, FHRS ; Engel, Gregory, MD ; Kong, Melissa H., MD, FHRS ; Fleming, William, BS ; Patrawala, Rob A., MD, FHRS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-9dfb41b3e1a7274e999b54a67f4ab44aef42d459772b24e8ee31173d545bb6423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Ablation outcomes</topic><topic>Aged</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Atrial fibrillation ablation</topic><topic>Cardiovascular</topic><topic>Catheter ablation</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheter Ablation - methods</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Humans</topic><topic>Long Term Adverse Effects - diagnosis</topic><topic>Long Term Adverse Effects - etiology</topic><topic>Long Term Adverse Effects - prevention & control</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Predictive Value of Tests</topic><topic>Radiofrequency ablation</topic><topic>Recurrence</topic><topic>Research Design</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Winkle, Roger A., MD, FHRS</creatorcontrib><creatorcontrib>Jarman, Julian W.E., MD</creatorcontrib><creatorcontrib>Mead, R. Hardwin, MD, FHRS</creatorcontrib><creatorcontrib>Engel, Gregory, MD</creatorcontrib><creatorcontrib>Kong, Melissa H., MD, FHRS</creatorcontrib><creatorcontrib>Fleming, William, BS</creatorcontrib><creatorcontrib>Patrawala, Rob A., MD, FHRS</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Winkle, Roger A., MD, FHRS</au><au>Jarman, Julian W.E., MD</au><au>Mead, R. Hardwin, MD, FHRS</au><au>Engel, Gregory, MD</au><au>Kong, Melissa H., MD, FHRS</au><au>Fleming, William, BS</au><au>Patrawala, Rob A., MD, FHRS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting atrial fibrillation ablation outcome: The CAAP-AF score</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>13</volume><issue>11</issue><spage>2119</spage><epage>2125</epage><pages>2119-2125</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Patients with a variety of clinical presentations undergo atrial fibrillation (AF) ablation. Long-term ablation success rates can vary considerably. Objective The purpose of this study was to develop a clinical scoring system to predict long-term freedom from AF after ablation. Methods We retrospectively derived the scoring system on a development cohort (DC) of 1125 patients undergoing AF ablation and tested it prospectively in a test cohort (TC) of 937 patients undergoing AF ablation. Results The demographics of the DC patients were as follows: age 62.3 ± 10.3 years, male sex 801 (71.2%), left atrial size 4.30 ± 0.69 cm, paroxysmal AF 348 (30.9%), number of drugs failed 1.3 ± 1.1, hypertension 525 (46.7%), diabetes 100 (8.9%), prior stroke/transient ischemic attack 78 (6.9%), prior cardioversion 528 (46.9%), and CHADS2 score 0.87 ± 0.97. Multivariate analysis showed 6 independent variables predicting freedom from AF after final ablation: coronary artery disease (P = .021), atrial diameter (P = .0003), age (P = .004), persistent or long-standing AF (P < .0001), number of antiarrhythmic drugs failed (P < .0001), and female sex (P = .0001). We created a scoring system (CAAP-AF) using these 6 variables, with scores ranging from 0 to 13 points. The 2-year AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 95.7%, 2 = 96.3%, 3 = 83.1%, 4 = 85.5%, 5 = 79.9%, 6 = 76.1%, 7 = 63.4%, 8 = 51.1%, 9 = 53.6%, and ≥10 = 29.1%. Ablation success decreased as CAAP-AF scores increased (P < .0001). The CAAP-AF score also predicted freedom from AF in the TC. The 2-year Kaplan-Meier AF-free rates by CAAP-AF scores were as follows: 0 = 100%, 1 = 87.0%, 2 = 89.0%, 3 = 91.6%, 4 = 90.5%, 5 = 84.4%, 6 = 70.1%, 7 = 71.0%, 8 = 60.7%, 9 = 68.9%, and ≥10 = 51.3%. As CAAP-AF scores increased, 2-year freedom from AF in the TC decreased (P < .0001). Conclusion An easily determined clinical scoring system was derived retrospectively and applied prospectively. The CAAP-AF score predicted freedom from AF after ablation in both a DC and a TC of patients undergoing AF ablation. The CAAP-AF score provides a realistic AF ablation outcome expectation for individual patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27435586</pmid><doi>10.1016/j.hrthm.2016.07.018</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-9481-6913</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Ablation outcomes Aged Anti-Arrhythmia Agents - therapeutic use Atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Atrial fibrillation ablation Cardiovascular Catheter ablation Catheter Ablation - adverse effects Catheter Ablation - methods Comorbidity Female Humans Long Term Adverse Effects - diagnosis Long Term Adverse Effects - etiology Long Term Adverse Effects - prevention & control Male Middle Aged Outcome and Process Assessment (Health Care) Predictive Value of Tests Radiofrequency ablation Recurrence Research Design Retrospective Studies Risk Assessment - methods Risk Factors United Kingdom - epidemiology |
| title | Predicting atrial fibrillation ablation outcome: The CAAP-AF score |
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