Abstract 11519: CHA ₂ DS ₂ VASc Score as a Predictor of Ablation Success Defined by Continuous Long-Term Monitoring

Introduction: There are few readily available and effective risk stratification tools for successful catheter ablation (CA) of atrial fibrillation (AF). CHA 2 DS 2 VASc score is a marker for vascular disease and has been shown to be mildly predictive of CA success, although prior studies have used short-term external monitors to define success. Hypothesis: Lower CHA 2 DS 2 VASc score correlates with CA success as measured by continuous monitoring via cardiac implantable electronic devices (CIED). Methods: Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink device database, we identified patients who underwent a 1 st CA procedure for AF following CIED implantation. CA success was defined as absence of ≥1 hour of AF on any day following a 3-month blanking period. A proportional hazard model was used to estimate hazard ratios (HR) between CHA 2 DS 2 VASc subgroups (0-2, 3-4, ≥5). Results: A total of 665 patients (age 66.9±9.1 years, 73.4% male, CHA 2 DS 2 VASc 3.5±1.8, 37.3% paroxysmal AF, 62.7% persistent AF) were analyzed and included 36.2% insertable cardiac monitor, 28.0% PPM, 21.4% ICD, 13.2% CRT-D, and 1.2% CRT-P. CA success at 24 months post blanking period was 39.8% (95% CI 32.4%-48.9%), 36.9% (95% CI 29.7%-45.8%), and 20.9% (95% CI 13.9%-31.4%) for CHA 2 DS 2 VASc subgroups of 0-2, 3-4, and ≥5, respectively. Kaplan-Meier curves demonstrate a difference in survival free from AF between the three CHA 2 DS 2 VASc subgroups (p=0.007, Figure), with CHA 2 DS 2 VASc score being a significant predictor of CA ablation success (c-statistic 0.533). After controlling for AF type, patients with a score ≥5 remained at higher risk for AF recurrence compared to patients with a score of 0-2 (HR 1.28, 95% CI 1.001-1.63). Conclusions: In this real-world dataset of AF patients with continuous monitoring undergoing CA, CHA 2 DS 2 VASc score is a modest predictor of CA success.