The HATCH and CHA2DS 2-VASc scores. Prognostic value in pulmonary vein isolation

Abstract

Aims: The HATCH score describes the risk of paroxysmal atrial fibrillation (Afib) progression, while the CHA2DS2vasc score depicts the risk of thromboembolic events in patients with Afib. We hypothesized that both scores may predict failure of Afib ablation.

Methods and results: In all, 449 consecutive patients (65.5 % male, mean age 61.7 ± 10.1 years) who presented to our institution for Afib ablation were investigated. A HATCH score of 0, 1, 2, 3, and ≥ 4 was found in 19.6, 50.3, 9.8, 15.6, and 4.6 % of the patients, respectively. A CHA2DS2vasc score of 0, 1, 2, 3, 4, 5, and > 5 was found in 10.7, 20.9, 25.1, 20.6, 15.0, 4.7, and 3.0 % of the patients, respectively (mean CHA2DS2vasc score, 2.4 ± 1.5). After 618 procedures (1.38 ± 0.55/patient), 84.3 % of patients were free of any atrial arrhythmia after a mean follow-up of 12.7 ± 7.1 months. The freedom of Afib after a single ablation procedure ranged between 50.7 and 60.3 % in patients with HATCH scores between 0 and 3 and dropped to 30.0 % in patients with a HATCH score greater than 3 (p = 0.041). The freedom of Afib after 1.38 procedures per patient ranged between 79.5 % and 88.4 % in patients with a HATCH score between 0 and 3 and was lower with a score of 4 or more (66.7 %, p = 0.064). Pulmonary vein isolation was equally successful in patients with a CHA2DS2vasc score of 5 or lower, but less effective in patients with a score greater than 5 (p = 0.013).

Conclusion: Pulmonary vein isolation is equally effective in patients with a low-to-moderate risk of disease progression and thromboembolic risk. However, the success rate seems to decrease in patients with high sores.