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. 2015 Oct;104(10):871-6.
doi: 10.1007/s00392-015-0856-x. Epub 2015 Apr 17.

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

Jelena Kornej  1 , Gerhard Hindricks  2 , M Benjamin Shoemaker  3 , Daniela Husser  2 , Arash Arya  2 , Philipp Sommer  2 , Sascha Rolf  2 , Pablo Saavedra  3 , Arvindh Kanagasundram  3 , S Patrick Whalen  3 , Jay Montgomery  3 , Christopher R Ellis  3 , Dawood Darbar  3 , Andreas Bollmann  2
Affiliations

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

Jelena Kornej et al. Clin Res Cardiol. 2015 Oct.

Abstract

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 CHADS2 and CHA2DS2-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 CHADS2 (AUC 0.538) and CHA2DS2-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 CHADS2 and CHA2DS2-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.

Keywords: AF recurrences; Atrial fibrillation; Catheter ablation; Risk scores.

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Conflict of interest statement

Conflict of interest There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
ROC curves for the CHADS2, CHA2DS2-VASc and APPLE scores in predicting AF recurrences
Fig. 2
Fig. 2
Distribution of AF recurrences within study population according to the APPLE score
See this image and copyright information in PMC

References

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