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. 2022 Aug 9;3(6Part A):656-664.
doi: 10.1016/j.hroo.2022.07.013. eCollection 2022 Dec.

Personalized assessment of the cumulative complication risk of the atrial fibrillation ablation track: The AF-TRACK calculator

Felipe Bisbal  1   2 , Juan-Pablo Abugattas  3 , Omar Trotta  4 , Juan José Gonzalez-Ferrer  5 , Assumpció Sauri-Ortiz  6 , Miguel Angel Arias  7 , Isaac Subirana  2 , Mattias Duytshaever  8   9 , Jan De Pooter  8 , Axel Sarrias  1 , Raquel Adeliño  1 , Francisco Alarcón  4 , Lluís Mont  2   4 , Julián Pérez-Villacastín  5 , Joaquin Osca-Asensi  6 , Roger Villuendas  1 , Marta Pachón-Iglesias  7 , Milad El Haddad  9 , Antoni Bayés-Genís  1   2 , Yves de Greef  3   10
Affiliations

Personalized assessment of the cumulative complication risk of the atrial fibrillation ablation track: The AF-TRACK calculator

Felipe Bisbal et al. Heart Rhythm O2. .

Abstract

Background: Atrial fibrillation (AF) ablation strategy is associated with a non-negligible risk of complications and often requires repeat procedures (AF ablation track), implying repetitive exposure to procedural risk.

Objective: The purpose of this study was to develop and validate a model to estimate individualized cumulative risk of complications in patients undergoing the AF ablation track (Atrial Fibrillation TRAck Complication risK [AF-TRACK] calculator).

Methods: The model was derived from a multicenter cohort including 3762 AF ablation procedures in 2943 patients. A first regression model was fitted to predict the propensity for repeat ablation. The AF-TRACK calculator computed the risk of AF ablation track complications, considering the propensity for repeat ablation. Internal (cross-validation) and external (independent cohort) validation were assessed for discrimination capacity (area under the curve [AUC]) and goodness of fit (Hosmer-Lemeshow [HL] test).

Results: Complications (N = 111) occurred in 3.7% of patients (2.9% of procedures). Predictors included female sex, heart failure, sleep apnea syndrome, and repeat procedures. The model showed fair discrimination capacity to predict complications (AUC 0.61 [0.55-0.67]) and likelihood of repeat procedure (AUC 0.62 [0.60-0.64]), with good calibration (HL χ2 12.5; P = .13). The model maintained adequate discrimination capacity (AUC 0.67 [0.57-0.77]) and calibration (HL χ2 5.6; P = .23) in the external validation cohort. The validated model was used to create the Web-based AF-TRACK calculator.

Conclusion: The proposed risk model provides individualized estimates of the cumulative risk of complications of undergoing the AF ablation track. The AF-TRACK calculator is a validated, easy-to-use, Web-based clinical tool to calibrate the risk-to-benefit ratio of this treatment strategy.

Keywords: Ablation; Atrial fibrillation; Complication; Prediction; Risk assessment.

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Figures

Figure 1
Figure 1
Discrimination capacity and calibration of the Atrial Fibrillation TRAck Complication risK (AF-TRACK) calculator. Receiving operator characteristics curves (A, B) and Hosmer-Lemeshow calibration tests (C, D) of the derivation and validation cohorts.
Figure 2
Figure 2
Case example of the Atrial Fibrillation TRAck Complication risK (AF-TRACK) calculator. Cumulative risk of complications and propensity for repeat procedure are provided. Details on the calculations for this example are given in the Supplementary Methods. AF = atrial fibrillation; LVEF = left ventricular ejection fraction.
Figure 3
Figure 3
Summary of model development and validation. The Atrial Fibrillation TRAck Complication risK (AF-TRACK) calculator is an externally validated tool that provides individualized estimates of the risk of complications of the atrial fibrillation (AF) ablation track, based on the risk of procedural complications and the propensity for repeat ablation. AUC = area under the curve; Cryo = cryoballoon; RF = radiofrequency.
Figure 4
Figure 4
Prevalence of risk factors by risk tertiles. AF = atrial fibrillation.
See this image and copyright information in PMC

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