title: The APPLE score: a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation.
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.
authors: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. jelena.kornej@gmx.de.
authors: Jelena
authors: J
authors: Kornej
authors: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
authors: Gerhard
authors: G
authors: Hindricks
authors: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: M Benjamin
authors: MB
authors: Shoemaker
authors: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
authors: Daniela
authors: D
authors: Husser
authors: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
authors: Arash
authors: A
authors: Arya
authors: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
authors: Philipp
authors: P
authors: Sommer
authors: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
authors: Sascha
authors: S
authors: Rolf
authors: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: Pablo
authors: P
authors: Saavedra
authors: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: Arvindh
authors: A
authors: Kanagasundram
authors: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: S
authors: S
authors: Patrick Whalen
authors: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: Jay
authors: J
authors: Montgomery
authors: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: Christopher R
authors: CR
authors: Ellis
authors: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: Dawood
authors: D
authors: Darbar
authors: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
authors: Andreas
authors: A
authors: Bollmann
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: AF recurrences; Atrial fibrillation; Catheter ablation; Risk scores