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

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 and Results 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. 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. Clinical Perspective What Is New? During a follow-up period of more than 6 years after CCW-AFL ablation, 107 of 271 (39.5%) patients developed NeAF. HAD-AF score, based on easily obtainable clinical, echocardiographic and electrocardiographic parameters, could better predict development of NeAF after CCW-AFL ablation (area under the receiver operating characteristics curve [AUC], 0.938), compared with currently used HATCH score (AUC, 0.651) and CHA2DS2-VAS C score (AUC, 0.679) (P<0.001). What Are the Clinical Implications? In CCW-AFL patients with a HAD-AF score >4, close postoperative follow-up for earlier detection of AF should be recommended, or the option of concomitant AF ablation could be considered during the shared decision-making process.