CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation

Abstract

The selection of patients with atrial fibrillation (AF) that will benefit most by left atrial ablation remains suboptimal. CHADS₂ score has been shown to be associated with post-ablation AF recurrences. However, data regarding the CHA₂DS₂-VASc score are lacking. In addition, there is paucity of data regarding the exact predictive value, in terms of sensitivity and specificity, of each of these scores as to AF recurrence. This study aimed to evaluate the merit of the CHADS₂ and CHA₂DS₂-VASc scores in predicting arrhythmia recurrence after a single ablation procedure for paroxysmal AF. One hundred and twenty-six patients (78 males, median age 61 years) with symptomatic paroxysmal AF underwent left atrial ablation. Over 16 months (interquartile range: 10.8–26.0), 89 patients were recurrence-free (70.6%). Larger left atrial volume (P: 0.039), diabetes (P: 0.001), dyslipidemia (P: 0.003), coronary artery disease (P: 0.003), class III antiarrhythmic drugs (P: 0.017), CHADS₂ (P: 0.006), and CHA₂DS₂-VASc (P: 0.016) scores were univariately associated with recurrence. In the multivariate analysis, both CHADS₂ (hazard ratio: 1.91, 95% confidence interval 1.09–3.36, P: 0.023) and CHA₂DS₂-VASc (hazard ratio: 1.97, 95% confidence interval 1.16–3.33, P: 0.012) were independently associated with AF recurrence. Cut-off analysis showed that a score ≥2 for both the CHADS₂ (sensitivity = 46% and specificity = 79%, area under the Receiver's operating characteristic curve, AUC = 0.644) and CHA₂DS₂-VASc score (sensitivity = 57% and specificity = 65%, AUC = 0.627) showed the highest predictive value for AF recurrence. CHA₂DS₂-VASc score is an independent predictor of left atrial ablation outcomes for paroxysmal AF, with a similar predictive value to CHADS₂. However, the predictive accuracy of both is mediocre.