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Title: Personalized assessment of the cumulative complication risk of the atrial fibrillation ablation track: The AF-TRACK calculator
Author: Bisbal, Felipe
Abugattas, Juan Pablo
Trotta, Omar
González Ferrer, Juan José
Saurí Ortiz, Assumpció
Arias, Miguel Ángel
Subirana Cachinero, Isaac
Duytshaever, Mattias
Pooter, Jan de
Sarrias, Axel
Adeliño, Raquel
Alarcón, Francisco
Mont Girbau, Lluís
Pérez Villacastín, Julián
Osca Asensi, Joaquin
Villuendas, Roger
Pachón Iglesias, Marta
El Haddad, Milad
Bayés Genís, Antoni
Greef, Yves de
Keywords: Arrítmia
Avaluació del risc
Risk assessment
Issue Date: 9-Aug-2022
Publisher: Heart Rhythm Society
Abstract: 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.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).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).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.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.© 2022 Heart Rhythm Society. Published by Elsevier Inc.
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It is part of: Heart Rhythm O2, 2022, vol. 3, num. 6, p. 656-664
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ISSN: 2666-5018
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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