The Predictive Value Of APPLE Score For Very Late Recurrence Of Atrial Fibrillation After Radio-frequency Ablation

Objective:1.To explore the predictive value of APPLE score in the recurrence of very late atrial fibrillation after radio-frequency ablation in Asian population with atrial fibrillation.2.To compare the predictive value of APPLE score with CHADS2,CHA2DS2-VASc and R2CHADS2 score for recurrence after RFCA,and plan to find a simple and effective scoring system to screen the low,medium and high risk groups of late recurrence after RFA,so as to select the patients suitable for interventional therapy for clinicians.Methods:From January 1,2014 to December 31,2018,339 patients who underwent RFCA in the Second Affiliated Hospital of Chongqing Medical University were included.The patients were divided into recurrence group and success group.The scores of APPLE,CHA2DS2-VASc,CHADS2 and R2CHADS2 were calculated for each patient,and the scores and general data were statistically analyzed.Results:A total of 339 patients were included,with an average follow-up of 23.09±17.62 months.At the end of the follow-up,125 patients(36.6%)had very late recurrence of AF.The results showed that the recurrence rate of AF increased with the increase of APPLE score.The linear?~2 trend test showed that there was a significant linear trend between the increase of APPLE score and the increase of recurrence rate(P=0.001).Compare the APPLE score(1 group:APPLE score=0,2 groups:APPLE score=1-2,3groups:APPLE score?3),the higher the APPLE score,the higher the incidence of hypertension and heart failure(P<0.05).And the diameter of left atrium enlarged more obviously(group 1 vs.2 vs.3=34.75±4.05mm vs.39.13±4.91mm vs.43.83±4.21mm,P<0.05).Persistent atrial fibrillation ratio,NT-ProBNP,stroke risk score(CHA2DS2-VASc,CHADS2,R2CHADS2)also increased with the increase of APPLE score,eGFR decreased with the increase of APPLE score(P<0.05).Compared with paroxysmal atrial fibrillation,the left atrial diameter,NT-ProBNP and APPLE scores of persistent atrial fibrillation were significantly greater than those of paroxysmal atrial fibrillation(P<0.05).The area under ROC curve showed that the best predictive value of APPLE score was AUC=0.603,the best cut-off value was APPLE?1,the sensitivity was 79.20%,and the specificity was 34.76%;the area under CHA2DS2-VASc,CHADS2 and R2CHADS2 were 0.525,0.519 and 0.523,respectively.Univariate Cox regression analysis showed that left atrial diameter(HR 1.06,P=0.001),eGFR(HR 0.99,P=0.019),eGFR?60ml/min/1.73m2(HR 1.86,P=0.024),NT-proBNP(HR 1.00,P=0.009),early recurrence of AF(HR 13.32,P=0.000),persistent atrial fibrillation(HR 1.51,P=0.023),APPLE score(HR 1.36;P=0.001)was an independent risk factor for late recurrence of AF.Multivariate Cox regression analysis showed that early recurrence of AF and APPLE score were independent risk factors for AF recurrence,and AF early recurrence was the most relevant risk factor for predicting AF very late recurrence(HR 13.89;95%CI 9.17-21.06;P<0.01).Conclusion:In this study,APPLE score and early recurrence of AF are independent risk factors for very late recurrence of AF,and early recurrence of AF is the strongest predictor.The APPLE score showed a moderate predictive value(AUC=0.603;P<0.05)for the late recurrence of AF after RFA.Stroke risk score(CHA2DS2-VASc,CHADS2,R2CHADS2)had no predictive value for the very late recurrence of AF after RFA.