Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems.

Abstract

Background

Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP-AF and APPLE) have been developed to predict the likelihood of AF recurrence after ablation, have not been validated specifically in patients with AF and HF.

Methods

We analyzed baseline characteristics, risk scores, and rates of AF recurrence 12 months postablation in a cohort of 230 consecutive patients with AF and HF undergoing PVI in the Duke Center for Atrial Fibrillation registry from 2009-2013.

Results

During a follow-up period of 12 months, 76 of 230 (33%) patients with HF experienced recurrent AF after ablation. The median APPLE and CAAP-AF scores were 1.5 ([Q1, Q3]: [1.0, 2.0]) and 4.0 ([Q1, Q3]: [3.0, 5.0]), respectively and were not different from those patients with and without recurrent AF. Freedom from AF was not different according to APPLE and CAAP-AF scores. Discrimination for recurrent AF with the CAAP-AF score was modest with a C-statistic of 0.60 (95% CI 0.52-0.67). Discrimination with the APPLE score was similarly modest, with a C-statistic of 0.54 (95% CI: 0.47-0.62).

Conclusions

Validated predictive risk scores for recurrent AF after catheter ablation exhibit limited predictive ability in cohorts of AF and HF. Additional tools are needed to facilitate risk stratification and patient selection for AF ablation in patients with concomitant HF.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1111/pace.13805

Publication Info

Black-Maier, Eric, Alice Parish, Benjamin A Steinberg, Cynthia L Green, Zak Loring, Adam S Barnett, Sana M Al-Khatib, Brett D Atwater, et al. (2019). Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems. Pacing and clinical electrophysiology : PACE, 42(11). pp. 1440–1447. 10.1111/pace.13805 Retrieved from https://hdl.handle.net/10161/30483.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Parish

Alice Parish

Biostatistician III

Education: Master of Science in Public Health, Biostatistics-  Emory University Rollins School of Public Health.  

Overview: Alice collaborates with researchers and clinicians with the Division of Gastroenterology on many observational studies using data from EHR as well as large national databases such as HCUP, UNOS, and Medicare 5% LDS.  Additionally, Alice collaborates with the Division of Pulmonary on palliative care RCTs and various retrospective studies.  Alice works with the Pharmacy residents on their PGY1 studies.  In the past Alice has had the opportunity to work with investigators in Heart Center and Epicenter.  Alice has experience working with zero inflated count outcomes, among many other statistical methodologies.

Loring

Zak Loring

Assistant Professor of Medicine

I am a cardiac electrophysiologist specializing in the treatment of heart rhythm disorders and management of cardiac implantable electronic devices (CIEDs). My research utilizes signal processing of electrocardiographic data and novel analytic techniques to better phenotype patients and identify those for whom interventional electrophysiology procedures may be most beneficial. This includes predicting which patients with left bundle branch block may benefit from early cardiac resynchronization therapy or conduction system pacing. I also analyze population level data to identify patients at high risk for adverse sequelae of rhythm disorders who may benefit from early intervention.

Daubert

James Patrick Daubert

Professor of Medicine

Atrial fibrillation ablation.
Cardiac resynchronization therapy.
Implantable defibrillator, including inappropriate shocks.
Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Hypertrophic cardiomyopathy.
Long QT syndrome
Sudden cardiac arrest and resuscitation.
Ventricular tachycardia

Frazier

Camille Genise Frazier

Professor of Medicine
Hegland

Donald Dale Hegland

Associate Professor of Medicine
Koontz

Jason Koontz

Associate Professor of Medicine

Robert Kenneth Lewis

Assistant Professor of Medicine
Pokorney

Sean Pokorney

Assistant Professor of Medicine
Sun

Albert Y. Sun

Associate Professor of Medicine
Bahnson

Tristram Dan Bahnson

Professor of Medicine

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