A Simple Score to Predict New-onset Atrial Fibrillation After Ablation of Typical Atrial Flutter

Zhoushan Gu; Jincheng Jiao; Youmei Shen; Xiangwei Ding; Chao Zhu; Mingfang Li; Hongwu Chen; Weizhu Ju; Kai Gu; Gang Yang; Hailei Liu; Pipin Kojodjojo; Minglong Chen

doi:10.1016/j.cjca.2024.02.006

A Simple Score to Predict New-onset Atrial Fibrillation After Ablation of Typical Atrial Flutter

Can J Cardiol. 2024 Feb 16:S0828-282X(24)00100-4. doi: 10.1016/j.cjca.2024.02.006. Online ahead of print.

Authors

Zhoushan Gu¹, Jincheng Jiao², Youmei Shen³, Xiangwei Ding⁴, Chao Zhu³, Mingfang Li³, Hongwu Chen³, Weizhu Ju³, Kai Gu³, Gang Yang³, Hailei Liu⁵, Pipin Kojodjojo⁶, Minglong Chen³

Affiliations

¹ Division of Cardiology, Affiliated Hospital of Nantong University, Nantong, China.
² Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.
³ Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁴ Division of Cardiology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University.
⁵ Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: liuhailei@njmu.edu.cn.
⁶ Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, Ng Teng Fong General Hospital, Singapore.

PMID: 38369258
DOI: 10.1016/j.cjca.2024.02.006

Abstract

Background: New-onset atrial fibrillation (NeAF) is common after cavotricuspid isthmus-dependent counterclockwise atrial flutter (CCW-AFL) ablation. This study aimed to investigate a simple predictive model of NeAF after CCW-AFL ablation.

Methods: From January 2013 to December 2017, consecutive patients receiving CCW-AFL ablation were enrolled from three centers. Clinical, echocardiographic, and electrocardiographic data were collected and followed. Patients from two centers and another center were assigned into the derivation and validation cohorts, respectively. In the derivation cohort, logistic regression was performed to evaluate the ability of parameters to discriminate those with and without NeAF. A score system was developed and then validated.

Results: Two hundred seventy-one patients (mean 59.7±13.6 age; 205 male) were analyzed. During follow-up (73.0±6.5 months), 107 patients (39.5%) had NeAF. 190 and 81 patients were detected in the derivation and validation cohorts, respectively. Hypertension, age ≥70 years, left atrial diameter ≥42 mm, P wave duration ≥120 ms and the negative component of flutter wave in lead II ≥120 ms were selected as the final parameters. A weighted score was used to develop the HAD-AF score ranging from 0 to 9. In the derivation cohort, area under the receiver operating characteristic curve (AUC) was 0.938 (95% CI 0.902-0.974), superior to those of currently used CHA₂DS₂-VAS_C (0.679, 95% CI 0.600-0.757) and HATCH scores (0.651, 95% CI 0.571-0.730) (P<0.001). Performance maintained in the validation cohort.

Conclusions: 39.5% of patients developed NeAF in 6 years after CCW-AFL ablation. HAD-AF score can reliably identify patients likely to develop NeAF after CCW-AFL ablation.

Keywords: atrial flutter; echocardiogram; electrocardiogram; new-onset atrial fibrillation; predictors; score system.