Predictors of Progression and Prognosis of Paroxysmal Atrial Fibrillation

Kim, Ji Eun; Lee, Ki Hong; Lee, Seunghun; Park, Hyukjin; Kim, Hyun Kuk; Kim, Sung Soo; Jeong, Hae Chang; Cho, Jae Yeong; Park, Keun Ho; Sim, Doo Sun; Yoon, Hyun Joo; Yoon, Nam Sik; Park, Hyung Wook; Kim, Kye Hun; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun

Abstract

BACKGROUND/AIMS
Significant numbers of patients with paroxysmal atrial fibrillation (AF) proceed to persistent AF and have poor clinical outcomes despite the use of antiarrhythmic agents or direct-current cardioversion. We compared the CHADS2, CHA2DS2-VASc, and HATCH scoring systems to predict AF progression and prognosis and identify the most useful scoring system in Korea.
METHODS
A total of 559 consecutive patients with paroxysmal symptomatic AF were analyzed. The progression of AF and clinical outcomes were determined after at least 1 year of follow-up. Clinical outcomes were defined as the composite of death, hospitalization due to heart failure, and new-onset stroke. Each score was calculated, and its predictive accuracy for AF progression and prognosis was compared.
RESULTS
A total of 147 patients with paroxysmal AF (26.3%) proceeded to persistent AF. The HATCH score (area under the curve [AUC], 0.601; p < 0.001) was the most powerful scoring system for the prediction of AF progression, although the CHADS2 (AUC, 0.565) and CHA2DS2-VASc (AUC, 0.558) were also useful. The CHA2DS2-VASc (AUC, 0.734; p < 0.001) was the most powerful scoring system for the prediction of clinical outcomes with a more significant linear correlation (0: 3.3% vs. 1: 6.3% vs. 2: 15.4% vs. 3: 20.7% vs. 4: 18.0% vs. 5: 53.6% vs. > or = 6: 55.6%, linear p < 0.001) than the CHADS2 (AUC, 0.720) and HATCH scoring systems (AUC, 0.723).
CONCLUSIONS
Although the CHADS2, CHA2DS2-VASc, and HATCH scoring systems were useful predictors of progression from paroxysmal to persistent AF, the CHA2DS2-VASc score was the most useful and accurate for the prediction of clinical outcomes.