Role of CHA2DS2-VASc score in predicting atrial fibrillation recurrence in patients undergoing pulmonary vein isolation with cryoballoon ablation

Abstract

Background: Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF). The CHA₂DS₂-VASc score is a well-established predictor of AF-related stroke. Whether the CHA₂DS₂-VASc score can also be useful in predicting the long-term clinical outcomes following PVI-C is still unsettled. The aim of this analysis was to evaluate the role of the CHA₂DS₂-VASc score in predicting AF recurrence after PVI-C.

Methods: Patients with symptomatic AF underwent an index PVI-C. Data were collected prospectively in the framework of the 1STOP ClinicalService project. Patients were categorized into two groups: low risk (LR) and high risk (HR) based on CHA₂DS₂-VASc score (0-1 and ≥ 2, respectively).

Results: Out of 3313 patients, 1910 (57.6%) had a CHA₂DS₂-VASc score between 0 and 1, while 1403 (42.3%) had CHA₂DS₂-VASc > = 2. Patient characteristics were significantly different between the two cohorts, including age, sex, BMI, paroxysmal AF, history of stroke, diabetes, and ischemic cardiomyopathy. On the contrary, procedural times and acute complications were comparable. The 36-month freedom from AF after a single procedure was 72.5% (95% CI: 69.8-75.0) in the LR group and 65.9% (95% CI: 62.3-69.2) in the HR score group (HR: 1.26, 95% CI: 1.08-1.47, p = 0.001). After multivariate analysis, higher CHA₂DS₂-VASc score was still a significant predictor of the risk of AF recurrence (HR: 1.33; 1.10-1.60, p = 0.003).

Conclusions: PVI-C is highly effective in the treatment of AF over the long term. A CHA₂DS₂-VASc score ≥ 2 is an independent predictor of AF recurrence during the follow-up and should be considered during the clinical management after the index procedure.

Keywords: AF recurrences; CHA2DS2-VASc; Cryoballoon; Outcomes; Paroxysmal atrial fibrillation; Persistent atrial fibrillation.