Background The clinical effectiveness of ablating non-paroxysmal atrial fibrillation (non-PAF) relies on proper patient selection. We developed and validated a scoring system to predict non-PAF ablation outcomes. Methods Data on 416 non-PAF ablations were analysed using binary logistic regression at a London centre. Identified preprocedural variables, which independently predicted freedom from atrial tachyarrhythmia. Twenty-one possible predictive variables and a model with c-statistic 0.751—explained outcome variation in London at mean follow-up 12±3 months. An additive point score (range 0–9) was developed—the FLAME score: female=1; long-lasting persistent atrial fibrillation=1; left atrial diameter in mm: 40 to <45 = 1, 45 to <50 = 2, 50 to <55=3, ≥55 =4; mitral regurgitation (MR) mild to moderate=1; extreme comorbidity=2. Extreme comorbidities include severe MR, moderate mitral stenosis, mitral replacement, hypertrophic cardiomyopathy or congenital heart disease. Results The FLAME score was applied to data (882 non-PAF ablations) at a Californian centre, and predicted the outcome of both single (p<0.0001) and multiple (p<0.0001) procedures. For first ablation (follow-up 2.1 years (median, IQR 1.0–4.1)), FLAME score: 0–1 predicts 62% success, 2–4 44% and ≥5 29% (Ptrend <0.0001). After the final ablation (mean procedures: 1.4±0.6, follow-up 1.8 years (median, IQR 0.8–3.6)), FLAME score: 0–1 predicts 81% success, 2–4 65% and ≥5 44% (Ptrend <0.0001). Conclusions FLAME score is easily calculated, derived in London, and predicted single and multiple procedural outcomes for non-PAF ablations in California. In patients with a high score, even multiple procedures are usually ineffective. Data are available on reasonable request.

中文翻译：

---

预测非阵发性房颤消融结果的国际验证评分：“FLAME 评分”

背景 消融非阵发性心房颤动 (non-PAF) 的临床有效性取决于正确的患者选择。我们开发并验证了一个评分系统来预测非 PAF 消融结果。方法 在伦敦中心使用二元逻辑回归分析了 416 次非 PAF 消融的数据。确定了独立预测无房性快速性心律失常的术前变量。21 个可能的预测变量和一个 c 统计量为 0.751 的模型——解释了伦敦平均随访 12±3 个月的结果变化。开发了一个附加分数（范围 0-9）——FLAME 分数：女性=1；长期持续性房颤=1；左心房直径（mm）：40 to <45 = 1, 45 to <50 = 2, 50 to <55=3, ≥55 =4; 二尖瓣关闭不全（MR）轻度至中度=1；极端合并症=2。极端合并症包括重度 MR、中度二尖瓣狭窄、二尖瓣置换术、肥厚型心肌病或先天性心脏病。结果 FLAME 评分应用于加利福尼亚中心的数据（882 次非 PAF 消融），并预测单次（p<0.0001）和多次（p<0.0001）手术的结果。对于第一次消融（随访 2.1 年（中位数，IQR 1.0–4.1）），FLAME 评分：0–1 预测成功率为 62%，2–4 44% 和≥5 29%（Ptrend <0.0001）。最终消融后（平均程序：1.4±0.6，随访 1.8 年（中位数，IQR 0.8-3.6）），FLAME 评分：0-1 预测成功率为 81%，2-4 65% 和 ≥5 44%（Ptrend <0.0001)。结论 FLAME 评分很容易计算，在伦敦得出，并预测加利福尼亚非 PAF 消融的单个和多个程序结果。在得分高的患者中，即使是多个程序通常也是无效的。可应合理要求提供数据。