Skip to main content
SpringerLink
Log in

Subjective assessment of complexity and prognosis after pulmonary vein isolation as significant predictor for procedural success

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Subjective estimation of recurrence after atrial fibrillation ablation is an important tool in clinical use. The aim of this study is to evaluate (1) if the subjective complexity of an atrial fibrillation ablation procedure is correlated with rhythm stability and (2) if the subjective prognosis of the operator has a predictive value.

Methods

We prospectively enrolled patients admitted for ablation of atrial fibrillation. Two scores were given immediately after the procedure by the operator: the complexity and the prognosis scores. With routine follow-ups, we tried to evaluate the correlation between the subjective scores and measured outcome.

Results

The study population included 611 patients (63 ± 10 years, 37% females, 61% persistent AF). During follow-up (FU) (median 24, IQR 7–36 months), recurrences occurred in 44% patients. Both scores (prognosis and complexity) correlated significantly with age, persistent AF, LA diameter, procedural characteristics, and recurrences. On multivariable analysis, complexity (OR 1.304, 95%CI 1.016–1.675, p = 0.037) and prognosis (OR 1.443, 95%CI 1.080–1.982, p = 0.013) scores remained significant predictors for arrhythmia recurrences. On ROC analysis, both scores showed significant predictive value for rhythm outcomes after catheter ablation (AUC 0.599 and 0.613, both p < 0.001 for complexity and prognosis scores, respectively).

Conclusions

Complexity and prognosis scores are significant predictors for arrhythmia recurrences after AF catheter ablations and even independent when competing with simple risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The medical data is stored in Leipzig Heart Center.

Code availability

Not applicable.

References

  1. Camm A.J, Lip G, De Caterina R, et al. ESC Committee for Practice Guidelines (CPG) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. European Heart Journal. 2012;33:2719–2747.

  2. Sultan A, Lüker J, Andresen D, Kuck KH, Hoffmann E, Brachmann J, Hochadel M, Willems S, Eckardt L, Lewalter T, Senges J, Steven D. Predictors of atrial fibrillation recurrence after catheter ablation: data from the German Ablation Registry. Sci Rep. 2017;7:16678.

    Article  CAS  Google Scholar 

  3. Schreiber D, Rostock T, Fröhlich M, Sultan A, Servatius H, Hoffmann BA, Lüker J, Berner I, Schäffer B, Wegscheider K, Lezius S, Willems S, Steven D. Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success. Circ Arrhythm Electrophysiol. 2015;8:308–17.

    Article  Google Scholar 

  4. Yu HT, Yang PS, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Poor rhythm outcome of catheter ablation for early-onset atrial fibrillation in women - mechanistic insight. Circ J. 2018 24;82(9):2259–2268.

  5. Kuck KH, Brugada J, Fürnkranz A, Chun KRJ, Metzner A, Ouyang F, Schlüter M, Elvan A, Braegelmann KM, Kueffer FJ, Arentz T, Albenque JP, Kühne M, Sticherling C, Tondo C; FIRE AND ICE Investigators. Impact of female sex on clinical outcomes in the FIRE AND ICE trial of catheter ablation for atrial fibrillation. Circ Arrhythm Electrophysiol. 2018;11(5):e006204.

  6. Chilukuri K, Dalal D, Gadrey S, Marine JE, Macpherson E, Henrikson CA, Cheng A, Nazarian S, Sinha S, Spragg D, Berger R, Calkins H. A prospective study evaluating the role of obesity and obstructive sleep apnea for outcomes after catheter ablation of atrial fibrillation. Cardiovasc Electrophysiol. 2010;21:521–5.

    Article  Google Scholar 

  7. De Maat GE, Mulder BA, Berretty WL, Al-Jazairi MIH, Tan ES, Wiesfeld ACP, Mariani MA, Van Gelder IC, Rienstra M, Blaauw Y. Obesity is associated with impaired long-term success of pulmonary vein isolation: a plea for risk factor management before ablation. Open Heart. 2018;5(1):e000771.

    Article  Google Scholar 

  8. Sivasambu B, Balouch MA, Zghaib T, Bajwa RJ, Chrispin J, Berger RD, Ashikaga H, Nazarian S, Marine JE, Calkins H, Spragg DD. Increased rates of atrial fibrillation recurrence following pulmonary vein isolation in overweight and obese patients. J Cardiovasc Electrophysiol. 2018;29(2):239–45.

    Article  Google Scholar 

  9. D’Ascenzo F, Corleto A, Biondi-Zoccai G, Anselmino M, Ferraris F, di Biase L, Natale A, Hunter RJ, Schilling RJ, Miyazaki S, Tada H, Aonuma K, Yenn-Jiang L, Tao H, Ma C, Packer D, Hammill S, Gaita F. Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis. Int J Cardiol. 2013;167:1984–9.

    Article  Google Scholar 

  10. Kohári M, Zado E, Marchlinski FE, Callans DJ, Han Y. Left atrial volume best predicts recurrence after catheter ablation in patients with persistent and longstanding persistent atrial fibrillation. Pacing Clin Electrophysiol. 2014;37(4):422–9.

    Article  Google Scholar 

  11. Tzou WS, Marchlinski FE, Zado ES, Lin D, Dixit S, Callans DJ, Cooper JM, Bala R, Garcia F, Hutchinson MD, Riley MP, Verdino R, Gerstenfeld EP. Long-term outcome after successful catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:237–42.

    Article  Google Scholar 

  12. Letsas KP, Efremidis M, Giannopoulos G, Deftereos S, Lioni L, Korantzopoulos P, Vlachos K, Xydonas S, Kossyvakis C, Sideris A. CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation. Europace. 2014;16:202–7.

    Article  Google Scholar 

  13. Chao TF, Cheng CC, Lin WS, Tsao HM, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Suenari K, Li CH, Liu SH, Hartono B, Wu TJ, Chen SA. Associations among the CHADS(2) score, atrial substrate properties, and outcome of catheter ablation in patients with paroxysmal atrial fibrillation. Heart Rhythm. 2011;8(8):1155–9.

    Article  Google Scholar 

  14. Chao TF, Ambrose K, Tsao HM, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Suenari K, Li CH, Hartono B, Chang HY, Wu TJ, Chen SA. Relationship between the CHADS(2) score and risk of very late recurrences after catheter ablation of paroxysmal atrial fibrillation. Heart Rhythm. 2012;9(8):1185–91.

    Article  Google Scholar 

  15. Schmidt EU, Schneider R, Lauschke J, Wendig I, Bänsch D. The HATCH and CHA2DS 2-VASc scores. Prognostic value in pulmonary vein isolation. Herz. 2014;39(3):343–348.

  16. Kornej J, Hindricks G, Shoemaker MB, Husser D, Arya A, Sommer P, Rolf S, Saavedra P, Kanagasundram A, Patrick Whalen S, Montgomery J, Ellis CR, Darbar D, Bollmann A. The APPLE score: a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation. Clin Res Cardiol. 2015;104:871–6.

    Article  Google Scholar 

  17. Mesquita J, Ferreira AM, Cavaco D, Moscoso Costa F, Carmo P, Marques H, Morgado F, Mendes M, Adragão P. Development and validation of a risk score for predicting atrial fibrillation recurrence after a first catheter ablation procedure - ATLAS score. Europace. 2018;20:428–35.

    Article  Google Scholar 

  18. Wójcik M, Berkowitsch A, Greiss H, Zaltsberg S, Pajitnev D, Deubner N, Hamm CW, Pitschner HF, Kuniss M, Neumann T. Repeated catheter ablation of atrial fibrillation: how to predict outcome? Circ J. 2013;77:2271–9.

    Article  Google Scholar 

  19. Mujovic N, Marinkovic M, Markovic N, Shantsila A, Lip GY, Potpara TS. Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: the MB-LATER clinical score. Sci Rep. 2017;7:40828. https://doi.org/10.1038/srep40828.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Mrs. E. Gomez for providing language help.

Author information

Authors and Affiliations

  1. Department of Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany

    Annina Stauber, J. Kornej, S. Hilbert, N. Dagres, A. Bollmann & G. Hindricks

  2. Heart Center, Triemli, Birmensdorferstr. 497, 8063, Zürich, Switzerland

    Annina Stauber

  3. Leipzig Heart Institute, Russenstr. 69a, 04289, Leipzig, Germany

    G. Hindricks

  4. Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany

    P. Sommer

Authors
  1. Annina Stauber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Kornej
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Hilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Dagres
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Bollmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Hindricks
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Sommer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Stauber: conception or design of the work, data acquisition, data interpretation, writing the manuscript, critical revision of the manuscript, approved the version to be published.

Kornej: statistics, data interpretation, writing the manuscript, critical revision of the manuscript, approved the version to be published.

Hilbert: critical revision, approved the version to be published.

Dagres: critical revision, approved the version to be published.

Bollmann: critical revision, approved the version to be published.

Hindricks: conception or design of the work, critical revision, approved the version to be published.

Sommer: conception or design of the work, data interpretation, project leader and project supervision, critical revision, approved the version to be published.

Corresponding author

Correspondence to Annina Stauber.

Ethics declarations

Ethics approval

The Leipzig AF Cohort was approved by the Ethics Committee.

Consent to participate

All patients gave written informed consent to the procedure.

Consent for publication

Patients gave written informed consent to the Leipzig AF Ablation Cohort.

Conflict of interest

PS has received lecture fees and travel support from Abbott and is a member of the advisory board for Abbott and Biosense Webster.

GH received research grants through the heart center Leipzig from Abbott and Boston Scientific. He has not received any personal payments for these purposes.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stauber, A., Kornej, J., Hilbert, S. et al. Subjective assessment of complexity and prognosis after pulmonary vein isolation as significant predictor for procedural success. J Interv Card Electrophysiol 64, 367–374 (2022). https://doi.org/10.1007/s10840-021-01005-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-021-01005-y

Keywords

Search

Navigation