Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-12-02 , DOI: 10.1007/s00392-021-01973-1 Björn Müller-Edenborn 1, 2 , Zoraida Moreno-Weidmann 1, 3 , Martin Eichenlaub 1 , Heiko Lehrmann 1 , Thomas Arentz 1 , Amir Jadidi 1 , José Guerra 3 , Concepcion Alonso-Martín 3 , Victor Bazan 3 , Xavier Vinolas 3 , Enrique Rodriguez-Font 3 , Bieito Campos Garcia 3 , Sandrine Venier 4 , Pascale Defaye 4 , Chan-il Park 5 , Serge Boveda 6 , Stéphane Combes 6 , Jean-Paul Albenque 6 , Benoit Guy-Moyat 7 , Dietmar Trenk 8 , Juan Chen 9 , Franz-Josef Neumann 10
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Aims
Despite advances in interventional treatment strategies, atrial fibrillation (AF) remains associated with significant morbidity and mortality. Fibrotic atrial myopathy (FAM) is a main factor for adverse outcomes of AF-ablation, but complex to diagnose using current methods. We aimed to derive a scoring system based entirely on easily available clinical parameters to predict FAM and ablation-success in everyday care.
Methods
In this multicenter, prospective study, a new risk stratification model termed AF-SCORE was derived in 220 patients undergoing high-density left-atrial(LA) voltage-mapping to quantify FAM. AF-SCORE was validated for FAM in an external mapping-validation cohort (n = 220) and for success following pulmonary vein isolation (PVI)-only (without adjunctive left- or right atrial ablations) in an external outcome-validation cohort (n = 518).
Results
FAM was rare in patients < 60 years (5.4%), but increased with ageing and affected 40.4% (59/146) of patients ≥ 60 years. Sex and AF-phenotype had additional predictive value in older patients and remained associated with FAM in multivariate models (odds ratio [OR] 6.194, p < 0.0001 for ≥ 60 years; OR 2.863, p < 0.0001 for female sex; OR 41.309, p < 0.0001 for AF-persistency). Additional clinical or diagnostic variables did not improve the model. AF-SCORE (+ 1 point for age ≥ 60 years and additional points for female sex [+ 1] and AF-persistency [+ 2]) showed good discrimination to detect FAM (c-statistic 0.792) and predicted arrhythmia-freedom following PVI (74.3%, 54.7% and 45.5% for AF-SCORE ≤ 2, 3 and 4, respectively, and hazard ratio [HR] 1.994 for AF-SCORE = 3 and HR 2.866 for AF-SCORE = 4, p < 0.001).
Conclusions
Age, sex and AF-phenotype are the main determinants for the development of FAM. A low AF-SCORE ≤ 2 is found in paroxysmal AF-patients of any age and younger patients with persistent AF irrespective of sex, and associated with favorable outcomes of PVI-only. Freedom from arrhythmia remains unsatisfactory with AF-SCORE ≥ 3 as found in older patients, particularly females, with persistent AF, and future studies investigating adjunctive atrial ablations to PVI-only should focus on these groups of patients.
Graphical abstract
中文翻译：
心房颤动中纤维化心房心肌病的决定因素。RETAC（reseau européen de traîtement d'arrhythmies cardiaques）组的多中心观察性研究
宗旨
尽管介入治疗策略取得了进展，但心房颤动 (AF) 仍然与显着的发病率和死亡率相关。纤维化心房肌病 (FAM) 是 AF 消融不良结果的主要因素，但使用当前方法诊断起来很复杂。我们的目标是建立一个完全基于容易获得的临床参数的评分系统，以预测日常护理中的 FAM 和消融成功率。
方法
在这项多中心、前瞻性研究中，在 220 名接受高密度左心房 (LA) 电压映射以量化 FAM 的患者中得出了一种称为 AF-SCORE 的新风险分层模型。AF-SCORE 在外部标测验证队列 ( n = 220)中的 FAM和仅在肺静脉隔离 (PVI) 后成功（无辅助左心房或右心房消融）在外部结果验证队列中得到验证 ( n = 518）。
结果
FAM 在 < 60 岁的患者中很少见 (5.4%)，但随着年龄的增长而增加，并且影响 40.4% (59/146) 的 60 岁以上的患者。性别和AF-表型的老年患者有额外的预测值，并且仍然与在多变量模型FAM（比值比[OR] 6.194，相关联的p <0.0001≥60岁;或2.863，p <0.0001为女性性; OR 41.309，p < 0.0001 AF 持久性）。额外的临床或诊断变量并没有改善模型。AF-SCORE（年龄 ≥ 60 岁 + 1 分，女性 [+ 1] 和 AF 持续性 [+ 2]）显示出良好的辨别力，可检测 FAM（c 统计量为 0.792）并预测 PVI 后无心律失常（AF-SCORE ≤ 2、3 和 4 分别为 74.3%、54.7% 和 45.5%，AF-SCORE = 3 的风险比 [HR] 1.994，AF-SCORE = 4 的 HR 2.866，p < 0.001）。
结论
年龄、性别和 AF 表型是 FAM 发展的主要决定因素。低 AF-SCORE ≤ 2 见于任何年龄的阵发性 AF 患者和患有持续性 AF 的年轻患者，无论性别如何，并且与仅 PVI 的良好结果相关。AF-SCORE ≥ 3 的无心律失常仍不令人满意，如在患有持续性 AF 的老年患者（尤其是女性）中发现的那样，未来研究对仅 PVI 进行辅助心房消融的研究应侧重于这些患者组。
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