Risk stratification of 1-year atrial tachyarrhythmia recurrence after ablation in patients with persistent atrial fibrillation: ALADS-AF score

BACKGROUND: Atrial fibrillation (AF) is the most common atrial arrhythmia with high prevalence, low awareness, and low treatment rate in China. Catheter ablation (CA) is an effective treatment, but recurrence remains common in persistent AF (PsAF). The present study aimed to develop a tool for 1-year atrial tachyarrhythmia (ATa) recurrence risk stratification after de novo CA. METHODS: This multicenter, retrospective study collected data from four Chinese hospitals between January 2015 and May 2021. Eligible patients were randomly divided in a 2:1 ratio to development (DC) and test cohorts (TC). One-year ATa recurrence status was primarily obtained from existing medical records. Candidate risk factors for recurrence were initially identified through literature review and investigator consensus. Univariable and multivariable Cox regression analyses were performed to develop the model. The model's discrimination and calibration were evaluated in both cohorts to assess performance. RESULTS: A total of 1,689 patients who underwent de novo CA were included, with 1,126 in DC and 563 in TC. The mean age was 60.5 years, 71.9% were male, the mean PsAF duration was 2.6 years, and 26.1% experienced 1-year ATa recurrence within 3-12 months post-ablation. Recurrence was associated with older age, larger Left Atrial Diameter (LAD), longer AF duration, and female sex. The ALADS-AF score (Age, LAD, Duration of AF, Sex) was developed, with scores from 0 to 30 and a C-index of 0.57. CONCLUSIONS: The ALADS-AF score is a simple and user-friendly tool for stratifying the risk of 1-year ATa recurrence in patients with PsAF after de novo CA. It may facilitate pre-procedural discussions, help set realistic expectations regarding rhythm outcomes, and support consistent follow-up planning in patients undergoing ablation for PsAF.