Chuanyi Sang,1,* Renjie Gu,1,* Tian Xia,1,* Yameng Shao,2 Ye Zhu,1 Fukun Chen,1 Lei Sun,1 Xiang Gu,1 Chaoqun Zhang3 

1Department of Cardiology, Northern Jiangsu People’s Hospital, Yangzhou, 225000, People’s Republic of China; 2Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, 471000, People’s Republic of China; 3Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiang Gu, Department of Cardiology, Northern Jiangsu People’s Hospital, Yangzhou, 225000, People’s Republic of China, Email xgsubeidsl@163.com Chaoqun Zhang, Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, People’s Republic of China, Email xyfyxnkdsl@163.com

Objective: The CHA2DS2-VASc score and left atrial epicardial adipose tissue (LA-EAT) volume have been identified as potential risk factors for atrial fibrillation (AF) recurrence after ablation. However, there is currently a lack of research specifically examining the interaction between these two AF risk factors. This study aims to evaluate the predictive potential of combining CHA2DS2-VASc score and LA-EAT volume in predicting recurrence in patients with AF who undergo ablation.
Methods: The study encompassed a cohort of 507 patients who underwent ablation for AF finally. Follow-up assessments were conducted 1, 3, 6, and 12 months after ablation, including clinical evaluation, a 12-lead ECG, and 24-hour Holter monitoring. Recurrence was characterized by symptomatic or asymptomatic AF episodes or atrial tachycardia lasting more than 30 seconds, as evidenced by any ECG following the 3-month BP. Patients were stratified into groups based on the defined cut-off values of CHA2DS2-VASc score and LA-EAT volume. Cox regression analysis was employed to estimate the risk factor of AF recurrence after ablation. The interaction between CHA2DS2-VASc score and LA-EAT volume was assessed using the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI).
Results: 140 patients experienced AF recurrence after ablation during the follow-up period. Multivariable Cox regression analysis demonstrated that CHA2DS2-VASc score and LA-EAT volume were independent risk factors for AF recurrence. Patients with higher CHA2DS2-VASc score and LA-EAT volume exhibited a higher risk of recurrence than those with lower score and volume. Furthermore, a significant synergistic interaction existed between CHA2DS2-VASc score and LA-EAT volume. The LA-EAT volume and clinical model combination improved the predictive value reclassification, and discriminant abilities improved significantly.
Conclusion: There is a significant additive interaction between CHA2DS2-VASc score and LA-EAT volume, with the coexistence of both factors significantly increasing the risk of AF recurrence after ablation.

Keywords: atrial fibrillation, catheter ablation, CHA2DS2-VASc score, left atrial epicardial adipose tissue, recurrence