CHA₂DS₂VASc score as a predictor of ablation success defined by continuous long-term monitoring

Background: There are few reliable risk stratification tools for successful atrial fibrillation catheter ablation (AFCA) and most prior studies have used short-term external monitors to define success. CHA₂DS₂VASc score may be useful in predicting AF recurrence. We investigated whether CHA₂DS₂VASc score correlates with AFCA success as measured by continuous monitoring via cardiac implantable electronic devices (CIEDs). Methods: Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink™ database, we identified patients who underwent a 1st AFCA procedure following CIED implantation. Success was defined as absence of ≥ 1 h of AF following a 3-month blanking period. Results: A total of 632 patients (age 67 ± 9.1 years, 73.3% male, CHA₂DS₂VASc 3.6 ± 1.8, 36.9% paroxysmal AF) were analyzed and included 35.1% insertable cardiac monitor, 28.8% PPM, 21.4% ICD, 13.6% CRT-D, and 1.1% CRT-P. Success at 24 months post blanking period was 40.3% (95% CI 32.6–49.7%), 36.2% (95% CI 26.9–45.4%), and 21.8% (95% CI 14.6–32.5%) for CHA₂DS₂VASc subgroups of 0–2, 3–4, and ≥ 5, respectively. Median daily burden of AF was reduced to zero regardless of CHA₂DS₂VASc score, but there were significant differences in survival free from any AF ≥ 1 h between the three CHA₂DS₂VASc subgroups (p = 0.013). Patients with a score ≥ 5 had a HR of 1.29 (95% CI 1.00–1.67) for AF recurrence compared to patients with a score of 0–2, with similar results after controlling for AF type. Conclusions: In real‐world patients with continuous monitoring undergoing AFCA, only CHA₂DS₂VASc scores ≥ 5 predicted higher AF recurrence.