A novel risk model for very late return of atrial fibrillation beyond 1 year after cryoballoon ablation

the SCALE-CryoAF score

Graham Peigh, Rachel M. Kaplan, Aakash Bavishi, Celso L. Diaz, Jayson R. Baman, Richard Matiasz, Amar Trivedi, Prasongchai Sattayaprasert, Jeremiah Wasserlauf, Mark J. Shen, Tatjana S. Potpara, Alexandru Bogdan Chicos, Rishi Arora, Susan S Kim Koss, Albert Chao-tun Lin, Nishant Verma, Bradley Paul Knight, Rod S. Passman*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: Cryoballoon ablation (CBA) is an effective technique for pulmonary vein isolation (PVI). To date, there are no risk models to predict very late recurrence of atrial fibrillation (VLRAF) after CBA. Methods: Retrospective analysis of a single-center database was performed. Inclusion criteria included PVI using CBA for atrial fibrillation (AF) without additional ablation targets, follow-up > 365 days, and no recurrent AF between 90 and 365 days after procedure. The primary endpoint was recurrent AF > 30 s > 12 months post-CBA. A risk model was created using clinical variables. Results: Of 674 CBA performed from 2011 to 2016, 300 patients (200 male, 62.0 ± 9.9 years) met inclusion criteria. Of these, 159 (53.0%) patients had paroxysmal AF. Patients had an average of 9.5 ± 2.7 cryoballoon freezes, and no patients required additional radiofrequency ablation lesion sets. Over a follow-up of 995 ± 490 days, 77/300 (25.7%) patients exhibited VLRAF. Univariate and multivariate analyses demonstrated that Structural heart disease (1 point), Coronary artery disease (3 points), left Atrial diameter > 43 mm (1 point), Left bundle branch block (3 points), Early return of AF (4 points), and non-paroxysmal AF (3 points) were risk factors for VLRAF. Combining these variables into a risk model, SCALE-CryoAF, (min 0; max 15) predicted VLRAF with an area under the curve of 0.73. Conclusion: SCALE-CryoAF is the first risk model to specifically predict first recurrence of AF beyond 1 year, VLRAF, after CBA. Model discrimination demonstrates that SCALE-CryoAF predicts VLRAF after CBA significantly better than other risk models for AF recurrence.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StatePublished - Jan 1 2019

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Atrial Fibrillation
Recurrence
Pulmonary Veins
Bundle-Branch Block
Area Under Curve
Coronary Artery Disease
Heart Diseases
Multivariate Analysis
Databases

Keywords

  • Atrial fibrillation
  • Cryoballoon ablation
  • Risk score
  • Very late return of atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Peigh, Graham ; Kaplan, Rachel M. ; Bavishi, Aakash ; Diaz, Celso L. ; Baman, Jayson R. ; Matiasz, Richard ; Trivedi, Amar ; Sattayaprasert, Prasongchai ; Wasserlauf, Jeremiah ; Shen, Mark J. ; Potpara, Tatjana S. ; Chicos, Alexandru Bogdan ; Arora, Rishi ; Kim Koss, Susan S ; Lin, Albert Chao-tun ; Verma, Nishant ; Knight, Bradley Paul ; Passman, Rod S. / A novel risk model for very late return of atrial fibrillation beyond 1 year after cryoballoon ablation : the SCALE-CryoAF score. In: Journal of Interventional Cardiac Electrophysiology. 2019.
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title = "A novel risk model for very late return of atrial fibrillation beyond 1 year after cryoballoon ablation: the SCALE-CryoAF score",
abstract = "Purpose: Cryoballoon ablation (CBA) is an effective technique for pulmonary vein isolation (PVI). To date, there are no risk models to predict very late recurrence of atrial fibrillation (VLRAF) after CBA. Methods: Retrospective analysis of a single-center database was performed. Inclusion criteria included PVI using CBA for atrial fibrillation (AF) without additional ablation targets, follow-up > 365 days, and no recurrent AF between 90 and 365 days after procedure. The primary endpoint was recurrent AF > 30 s > 12 months post-CBA. A risk model was created using clinical variables. Results: Of 674 CBA performed from 2011 to 2016, 300 patients (200 male, 62.0 ± 9.9 years) met inclusion criteria. Of these, 159 (53.0{\%}) patients had paroxysmal AF. Patients had an average of 9.5 ± 2.7 cryoballoon freezes, and no patients required additional radiofrequency ablation lesion sets. Over a follow-up of 995 ± 490 days, 77/300 (25.7{\%}) patients exhibited VLRAF. Univariate and multivariate analyses demonstrated that Structural heart disease (1 point), Coronary artery disease (3 points), left Atrial diameter > 43 mm (1 point), Left bundle branch block (3 points), Early return of AF (4 points), and non-paroxysmal AF (3 points) were risk factors for VLRAF. Combining these variables into a risk model, SCALE-CryoAF, (min 0; max 15) predicted VLRAF with an area under the curve of 0.73. Conclusion: SCALE-CryoAF is the first risk model to specifically predict first recurrence of AF beyond 1 year, VLRAF, after CBA. Model discrimination demonstrates that SCALE-CryoAF predicts VLRAF after CBA significantly better than other risk models for AF recurrence.",
keywords = "Atrial fibrillation, Cryoballoon ablation, Risk score, Very late return of atrial fibrillation",
author = "Graham Peigh and Kaplan, {Rachel M.} and Aakash Bavishi and Diaz, {Celso L.} and Baman, {Jayson R.} and Richard Matiasz and Amar Trivedi and Prasongchai Sattayaprasert and Jeremiah Wasserlauf and Shen, {Mark J.} and Potpara, {Tatjana S.} and Chicos, {Alexandru Bogdan} and Rishi Arora and {Kim Koss}, {Susan S} and Lin, {Albert Chao-tun} and Nishant Verma and Knight, {Bradley Paul} and Passman, {Rod S.}",
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A novel risk model for very late return of atrial fibrillation beyond 1 year after cryoballoon ablation : the SCALE-CryoAF score. / Peigh, Graham; Kaplan, Rachel M.; Bavishi, Aakash; Diaz, Celso L.; Baman, Jayson R.; Matiasz, Richard; Trivedi, Amar; Sattayaprasert, Prasongchai; Wasserlauf, Jeremiah; Shen, Mark J.; Potpara, Tatjana S.; Chicos, Alexandru Bogdan; Arora, Rishi; Kim Koss, Susan S; Lin, Albert Chao-tun; Verma, Nishant; Knight, Bradley Paul; Passman, Rod S.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A novel risk model for very late return of atrial fibrillation beyond 1 year after cryoballoon ablation

T2 - the SCALE-CryoAF score

AU - Peigh, Graham

AU - Kaplan, Rachel M.

AU - Bavishi, Aakash

AU - Diaz, Celso L.

AU - Baman, Jayson R.

AU - Matiasz, Richard

AU - Trivedi, Amar

AU - Sattayaprasert, Prasongchai

AU - Wasserlauf, Jeremiah

AU - Shen, Mark J.

AU - Potpara, Tatjana S.

AU - Chicos, Alexandru Bogdan

AU - Arora, Rishi

AU - Kim Koss, Susan S

AU - Lin, Albert Chao-tun

AU - Verma, Nishant

AU - Knight, Bradley Paul

AU - Passman, Rod S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Cryoballoon ablation (CBA) is an effective technique for pulmonary vein isolation (PVI). To date, there are no risk models to predict very late recurrence of atrial fibrillation (VLRAF) after CBA. Methods: Retrospective analysis of a single-center database was performed. Inclusion criteria included PVI using CBA for atrial fibrillation (AF) without additional ablation targets, follow-up > 365 days, and no recurrent AF between 90 and 365 days after procedure. The primary endpoint was recurrent AF > 30 s > 12 months post-CBA. A risk model was created using clinical variables. Results: Of 674 CBA performed from 2011 to 2016, 300 patients (200 male, 62.0 ± 9.9 years) met inclusion criteria. Of these, 159 (53.0%) patients had paroxysmal AF. Patients had an average of 9.5 ± 2.7 cryoballoon freezes, and no patients required additional radiofrequency ablation lesion sets. Over a follow-up of 995 ± 490 days, 77/300 (25.7%) patients exhibited VLRAF. Univariate and multivariate analyses demonstrated that Structural heart disease (1 point), Coronary artery disease (3 points), left Atrial diameter > 43 mm (1 point), Left bundle branch block (3 points), Early return of AF (4 points), and non-paroxysmal AF (3 points) were risk factors for VLRAF. Combining these variables into a risk model, SCALE-CryoAF, (min 0; max 15) predicted VLRAF with an area under the curve of 0.73. Conclusion: SCALE-CryoAF is the first risk model to specifically predict first recurrence of AF beyond 1 year, VLRAF, after CBA. Model discrimination demonstrates that SCALE-CryoAF predicts VLRAF after CBA significantly better than other risk models for AF recurrence.

AB - Purpose: Cryoballoon ablation (CBA) is an effective technique for pulmonary vein isolation (PVI). To date, there are no risk models to predict very late recurrence of atrial fibrillation (VLRAF) after CBA. Methods: Retrospective analysis of a single-center database was performed. Inclusion criteria included PVI using CBA for atrial fibrillation (AF) without additional ablation targets, follow-up > 365 days, and no recurrent AF between 90 and 365 days after procedure. The primary endpoint was recurrent AF > 30 s > 12 months post-CBA. A risk model was created using clinical variables. Results: Of 674 CBA performed from 2011 to 2016, 300 patients (200 male, 62.0 ± 9.9 years) met inclusion criteria. Of these, 159 (53.0%) patients had paroxysmal AF. Patients had an average of 9.5 ± 2.7 cryoballoon freezes, and no patients required additional radiofrequency ablation lesion sets. Over a follow-up of 995 ± 490 days, 77/300 (25.7%) patients exhibited VLRAF. Univariate and multivariate analyses demonstrated that Structural heart disease (1 point), Coronary artery disease (3 points), left Atrial diameter > 43 mm (1 point), Left bundle branch block (3 points), Early return of AF (4 points), and non-paroxysmal AF (3 points) were risk factors for VLRAF. Combining these variables into a risk model, SCALE-CryoAF, (min 0; max 15) predicted VLRAF with an area under the curve of 0.73. Conclusion: SCALE-CryoAF is the first risk model to specifically predict first recurrence of AF beyond 1 year, VLRAF, after CBA. Model discrimination demonstrates that SCALE-CryoAF predicts VLRAF after CBA significantly better than other risk models for AF recurrence.

KW - Atrial fibrillation

KW - Cryoballoon ablation

KW - Risk score

KW - Very late return of atrial fibrillation

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U2 - 10.1007/s10840-019-00588-x

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