A new scoring system to predict the risk of late recurrence in extended follow-up after atrial fibrillation catheter ablation: APCEL score

Background

In studies where risk scores used to determine the risk of late recurrence after atrial fibrillation (AF) catheter ablation were defined, significant differences were observed in terms of parameters such as post-procedural follow-up time, pre-procedural AF time, energy sources used for ablation, and cut-off values of left atrium (LA) diameter. Considering all these factors, we aimed to develop a new recurrence risk score for prolonged follow-up after AF ablation.

Methods

The study included 206 patients who underwent index AF catheter ablation for paroxysmal or persistent AF. Independent predictors of late recurrence were identified at a median follow-up of 40 months (range: 21–57), and a risk score was created. The predictive ability of this score for late recurrence was compared with that of other risk scores.

Results

Independent predictors of late recurrence development included pre-ablation AF duration >19 months, persistent AF, early recurrence, chronic obstructive pulmonary disease, and LA volume index >31 mL/m². The APCEL risk score, derived from these factors (Early recurrence: 3 points, AF duration >19 months: 2 points, others: 1 point), demonstrated good predictive performance for late recurrence at 6th [AUC: 0.940, 95% CI: 0.896–0.983], 12th [AUC: 0.865, 95% CI: 0.796–0.932], 24th [AUC: 0.814, 95% CI: 0.743–0.885], and 36th months [AUC: 0.798, 95% CI: 0.726–0.868].

Conclusions

The APCEL score, calculated at the end of the blanking period for patients who underwent AF ablation, can effectively identify those at high risk of late recurrence during extended follow-up.