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Role of CHA2DS2-VASc score in predicting atrial fibrillation recurrence in patients undergoing pulmonary vein isolation with cryoballoon ablation

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Abstract

Background

Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF). The CHA2DS2-VASc score is a well-established predictor of AF-related stroke. Whether the CHA2DS2-VASc score can also be useful in predicting the long-term clinical outcomes following PVI-C is still unsettled. The aim of this analysis was to evaluate the role of the CHA2DS2-VASc score in predicting AF recurrence after PVI-C.

Methods

Patients with symptomatic AF underwent an index PVI-C. Data were collected prospectively in the framework of the 1STOP ClinicalService project. Patients were categorized into two groups: low risk (LR) and high risk (HR) based on CHA2DS2-VASc score (0–1 and ≥ 2, respectively).

Results

Out of 3313 patients, 1910 (57.6%) had a CHA2DS2-VASc score between 0 and 1, while 1403 (42.3%) had CHA2DS2-VASc > = 2. Patient characteristics were significantly different between the two cohorts, including age, sex, BMI, paroxysmal AF, history of stroke, diabetes, and ischemic cardiomyopathy. On the contrary, procedural times and acute complications were comparable. The 36-month freedom from AF after a single procedure was 72.5% (95% CI: 69.8–75.0) in the LR group and 65.9% (95% CI: 62.3–69.2) in the HR score group (HR: 1.26, 95% CI: 1.08–1.47, p = 0.001). After multivariate analysis, higher CHA2DS2-VASc score was still a significant predictor of the risk of AF recurrence (HR: 1.33; 1.10–1.60, p = 0.003).

Conclusions

PVI-C is highly effective in the treatment of AF over the long term. A CHA2DS2-VASc score ≥ 2 is an independent predictor of AF recurrence during the follow-up and should be considered during the clinical management after the index procedure.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

SAS software, version 9.4 (SAS Institute Inc., Cary, NC, USA), was used to perform statistical analyses.

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Acknowledgements

We would like to thank Hae Lim, an employee of Medtronic Inc, for his help in the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Arrhythmia and Electrophysiology Unit, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy

    Roberto Rordorf

  2. Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy

    Saverio Iacopino

  3. ULSS, 6 Euganea, Ospedale Di Camposampiero- Cittadella, Italy

    Roberto Verlato

  4. Ospedale Delle Apuane-, Massa Carrara, Italy

    Giuseppe Arena

  5. Heart Rhythm Center at Monzino Cardiac Center, IRCCS Department of Clinical Electrophysiology&Cardiac Pacing Department of Biomedical, Surgical and Dentistry Sciences, University of Milan, Milan, Italy

    Claudio Tondo

  6. IRCCS Sacro Cuore Don Calabria, Negrar, Italy

    Giulio Molon

  7. Ospedale San Maurizio, Bolzano, Italy

    Massimiliano Manfrin

  8. ASST San Gerardo Di Monza, Monza, Italy

    Giovanni Rovaris

  9. Ospedale San Luca, IRCCS Istituto Auxologico, Milan, Italy

    Giovanni Battista Perego

  10. Policlinico Casilino, Rome, Italy

    Luigi Sciarra

  11. Istituto Sant’Ambrogio, Milan, Italy

    Massimo Mantica

  12. ASST Vimercate, Vimercate, Italy

    Riccardo Sacchi

  13. Ospedale Careggi, University of Florence, Florence, Italy

    Paolo Pieragnoli

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  1. Roberto Rordorf
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Corresponding author

Correspondence to Roberto Rordorf.

Ethics declarations

Ethics approval

The project was approved by each site’s medical ethics committee or medical director, and it conforms to the principles outlined in the Declaration of Helsinki.

Consent to participate

Each patient provided informed consent for data collection and analyses.

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Conflict of interest

Roberto Rordorf received modest speaking fees from Abbott and Boston Scientific. Roberto Verlato received modest consultancy and speaker’s fees from Medtronic. Giulio Molon received modest consultancy fees from Medtronic and Boston Scientific and speaker’s fees from Medtronic, Boston Scientific, St. Jude, and Boehringer Ingelheim. Claudio Tondo serves as a member of the Medtronic European Advisory Board and Boston Scientific International Advisory Board. He received lecture and proctor fees from Medtronic, Abbott Medical, Biosense Webster, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this manuscript to disclose.

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Rordorf, R., Iacopino, S., Verlato, R. et al. Role of CHA2DS2-VASc score in predicting atrial fibrillation recurrence in patients undergoing pulmonary vein isolation with cryoballoon ablation. J Interv Card Electrophysiol 66, 1193–1200 (2023). https://doi.org/10.1007/s10840-022-01430-7

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