Predictive value of scoring systems (CHADS, CHADS2-VAS, APPLE, HATCH, BASE-AF2) in the choice of radiofrequency or cryoablation for Atrial Fibrillation ablation

Öz

Aim: Atrial fibrillation (AF) is a common arrhythmia that increases mortality and morbidity risks. AF can be managed with strategies for rate and rhythm control. For rhythm control, catheter ablations using thermal methods, specifically radiofrequency ablation (RFA) and cryoablation (CrA), are employed. However, the predictive value of existing scoring systems in determining the choice of ablation method has not been thoroughly investigated. This study aims to evaluate the predictive value of the CHADS2, CHA2DS2-VASc, APPLE, HATCH, and BASE-AF2 scoring systems in selecting RFA or CrA. Material and Methods: In this retrospective study conducted at Medipol Bahçelievler Hospital between January 2023 and April 2024, 111 patients who underwent successful AF ablation were analyzed. Patients were divided into two groups: those who underwent pulmonary vein isolation (PVI) only and those who received additional ablation beyond PVI. The study assessed the ability of various scoring systems to predict the need for additional ablation and also analyzed the patients' clinical and demographic characteristics. Results: Patients requiring additional ablation after PVI had higher APPLE and BASE-AF2 scores. Multivariate analysis identified APPLE and BASE-AF2 scores as independent predictors of long-standing persistent AF and the need for additional ablation. ROC analysis of APPLE and BASE-AF2 scores showed significant predictive value for additional ablation needs (AUC: 0.667 and 0.693, respectively). Conclusion: APPLE and BASE-AF2 scoring systems have been identified as effective tools for predicting the need for additional ablation after PVI. In the long term, these scores may assist in catheter selection and in determining the need for additional ablation. For patients requiring additional ablation, the choice of RFA catheters may offer greater maneuverability.

Anahtar Kelimeler

• Ablation
• Atrial fibrillation
• APPLE score
• BASE-AF2 score
• Cryoablation
• Radiofrequency

Atriyal fibrilasyon ablasyonunda radyofrekans veya kriyoablasyon seçimi yaparken skor sistemlerinin (CHADS, CHADS2-VAS, APPLE, HATCH, BASE-AF2) öngördürücülüğü

Öz

Amaç: Atriyal fibrilasyon (AF) sık görülen bir aritmi olup mortalite ve morbidite riskini artırır. AF tedavisinde hız ve ritim kontrolü stratejileri vardır. Ritim kontrolü amacıyla yapılan kateter ablasyonları, özellikle radyofrekans (RFA) ve kriyoablasyon (CrA) gibi termal ablasyon yöntemleri kullanılmaktadır. Ancak, hangi ablasyon yönteminin tercih edileceğini belirlemek için mevcut skor sistemlerinin öngördürücülüğü yeterince araştırılmamıştır. Bu çalışmanın amacı, CHADS2, CHA2DS2- VASc, APPLE, HATCH, BASE-AF2 skor sistemlerinin RFA veya CrA seçimi üzerindeki öngördürücülüğünü değerlendirmektir. Gereç ve Yöntemler: Ocak 2023-Nisan 2024 tarihleri arasında Medipol Bahçelievler Hastanesi'nde yapılan retrospektif çalışmada, 111 başarılı AF ablasyon hastası incelenmiştir. Hastalar, sadece pulmoner ven izolasyonu (PVI) yapılanlar ve PVI'ya ek ablasyon uygulananlar olarak iki gruba ayrılmıştır. Çalışmada, farklı skor sistemlerinin ek ablasyon ihtiyacını tahmin etme gücü değerlendirilmiştir. Ayrıca, hastaların klinik ve demografik özellikleri de analiz edilmiştir. Bulgular: PVI’ya ek ablasyon ihtiyacı olan hastalar daha yüksek APPLE ve BASE-AF2 skorlarına sahipti. Multivariant analizde APPLE ve BASE-AF2 skorları ile long persistan AF, ek ablasyon ihtiyacının bağımsız öngördürücüleri olarak belirlenmiştir. APPLE ve BASE-AF2 skorları ROC analizi ile değerlendirildiğinde, ek ablasyon ihtiyacını öngörmede anlamlı bulunmuştur (sırasıyla AUC: 0.667 ve 0.693). Sonuç: APPLE ve BASE-AF2 skorları, PVI sonrası ek ablasyon ihtiyacını öngörmede etkili araçlar olarak belirlenmiştir. Uzun vadede, bu skorlar kateter seçim sürecinde ve ek ablasyon ihtiyacının belirlenmesinde yardımcı olabilir. Ek ablasyon ihtiyacı olan hastalarda RFA kateterlerinin tercih edilmesi, daha geniş bir manevra kabiliyeti sağlayabilir.

Anahtar Kelimeler

• Ablasyon
• atriyal fibrilasyon
• APPLE skor
• BASE-AF2 skor
• Kriyoablasyon
• Radyofrekans

Teşekkür

İstatistiksel analiz ve değerlendirmeleri için sayın Hatice Eftal Şeyda Kanal'a teşekkür ederiz.

Kaynakça

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