Comparative Evaluation of 11 Prognostic Scores for Atrial Fibrillation Recurrence After Pulmonary Vein Isolation in Non-Paroxysmal AF: A Retrospective Comparative Analysis.

OBJECTIVE

Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation for atrial fibrillation (AF); however, a substantial proportion of patients with non-paroxysmal AF (non-PAF) experience recurrence following ablation. With numerous prognostic models available to predict recurrence, the aim of this study is to compare the predictive performance of multiple scoring systems in patients with non-PAF undergoing PVI as a standalone procedure.

METHODS

A retrospective analysis was conducted involving 166 patients with non-PAF (22.3% female; mean age 60 ± 9 years) who underwent initial PVI alone. Clinical data, including transthoracic echocardiography and either cardiac computed tomography or transesophageal echocardiography, were collected. The evaluated prognostic scoring systems included APPLE, BASE-AF2, C2HEST, CAAP-AF, CHA2DS2-VASc, CHADS2, DR-FLASH, HATCH, MB-LATER, PAT2C2H, and SCALE-CryoAF.

RESULTS

Recurrence of AF following a 90-day blanking period was observed in 41 individuals (24.7%), including 24 (51.8%) in the cryo-balloon ablation (CBA) subgroup and 17 (48.2%) in the radiofrequency catheter ablation (RFCA) subgroup. Among the evaluated models, BASE-AF2 (AUC = 0.666, 95% CI: 0.572-0.759, p = 0.001), MB-LATER (AUC = 0.734, 95% CI: 0.646-0.821, p < 0.001), and SCALE-CryoAF (AUC = 0.702, 95% CI: 0.600-0.804, p < 0.001) demonstrated superior prognostic performance for recurrence. After propensity score matching, MB-LATER (AUC = 0.734, 95% CI: 0.570-0.899, p = 0.019) was identified as the most effective predictor of recurrence in the CBA subgroup, while BASE-AF2 (AUC = 0.758, 95% CI: 0.578-0.937, p = 0.013) indicated superior predictive accuracy in the RFCA subgroup.

CONCLUSION

The BASE-AF2, MB-LATER, and SCALE-CryoAF scoring systems demonstrated enhanced prognostic use for predicting AF recurrence following PVI alone in patients with non-PAF. MB-LATER exhibited superior performance in those treated with CBA, while BASE-AF2 was more predictive for those who underwent RFCA.