The APPLE score: a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation

• Published in: Clinical research in cardiology Vol. 104; no. 10; pp. 871 - 876
• Main Authors: Kornej, Jelena, Hindricks, Gerhard, Shoemaker, M. Benjamin, Husser, Daniela, Arya, Arash, Sommer, Philipp, Rolf, Sascha, Saavedra, Pablo, Kanagasundram, Arvindh, Patrick Whalen, S., Montgomery, Jay, Ellis, Christopher R., Darbar, Dawood, Bollmann, Andreas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2015; Springer Nature B.V
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Cardiology; Catheter Ablation - statistics & numerical data; Echocardiography - statistics & numerical data; Female; Germany - epidemiology; Humans; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Outcome Assessment, Health Care - methods; Outcome Assessment, Health Care - statistics & numerical data; Prevalence; Recurrence; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; United States - epidemiology; United States; Germany; Risk scores; AF recurrences; Atrial fibrillation; Catheter ablation
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-015-0856-x

Background Recurrent atrial fibrillation (AF) occurs in up to 50 % of patients within 1 year after catheter ablation, and a clinical risk score to predict recurrence remains a critical unmet need. The aim of this study was to (1) develop a simple score for the prediction of rhythm outcome following catheter ablation; (2) compare it with the CHADS 2 and CHA 2 DS 2 -VASc scores, and (3) validate it in an external cohort. Methods Rhythm outcome between 3 and 12 months after AF catheter ablation were documented. The APPLE score [one point for age >65 years, persistent AF, impaired eGFR (<60 ml/min/1.73 m 2 ), LA diameter ≥43 mm, EF < 50 %] was associated with AF recurrence and was validated in an external cohort in 261 patients with comparable ablation and follow-up. Results In 1145 patients (60 ± 10 years, 65 % male, 62 % paroxysmal AF) the APPLE score showed better prediction of AF recurrences (AUC 0.634, 95 % CI 0.600–0.668, p  < 0.001) than CHADS 2 (AUC 0.538) and CHA 2 DS 2 -VASc (AUC 0.542). Compared to patients with an APPLE score of 0, the odds ratio for AF recurrences was 1.73, 2.79 and 4.70 for APPLE scores 1, 2, or ≥3, respectively (all p  < 0.05). In the external validation cohort, the APPLE score showed similar results (AUC 0.624, 95 % CI 0.562–0.687, p  < 0.001). Conclusions The novel APPLE score is superior to the CHADS 2 and CHA 2 DS 2 -VASc scores for prediction of rhythm outcome after catheter ablation. It holds promise as a useful tool to identify patients with low, intermediate, and high risk for AF recurrence.