Modified Hatch Score Predicts 6-Month Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation: Data from the University Of Massachusetts Atrial Fibrillation Registry

AIMS: Pre-procedural identification of patients with atrial fibrillation (AF) who will benefit most from pulmonary vein isolation remains challenging. The HATCH score [Hypertension x1 + Age≥75 x1 + Thrombo-embolic event x2, COPD x1, Heart failure x2] has been associated with progression of AF and recently with adverse outcomes after catheter ablation. However, data regarding the HATCH score are limited. This study aimed to evaluate the performance of a modified HATCH scoring system, including pre-procedural obstructive sleep apnea as an additional risk element, compared to the CHADS risk score as a predictor of AF recurrence after an index pulmonary vein isolation procedure for AF. METHODS AND RESULTS: Seventy eight patients (48 men, mean age 60 ± 1.1 years) with paroxysmal or persistent AF underwent an index pulmonary vein isolation procedure between 2010 and 2014 using either radiofrequency (n=64) or cryoballoon (n = 14). Over a 6-month follow-up period, 35 patients had recurrence (44.9%) when monitored using Holter monitoring and in-office ECGs. The modified HATCH score was associated on univariate testing with AF recurrence. In multivariate logistic regression analyses including factors known to be associated with AF recurrence, the modified HATCH score (p: 0.03) was independently associated with AF recurrence and showed superior test characteristics using ROC curve analysis (C statistic = 0.64 for modified HATCH vs. 0.55 for CHADS2). The difference between the modified HATCH and the CHADS2 scores in predicting recurrence was not statistically significant (p = 0.8). CONCLUSIONS: AF recurred in 44% of patients over a 6-month follow-up. A modified HATCH including OSA successfully identified individuals at risk for 6-month recurrence. Further research is needed including larger cohorts of patients undergoing ablation and followed for more extended periods to further validate the performance of the modified HATCH score

Addition of B-Type Natriuretic Peptide to Existing Clinical Risk Scores Enhances Identification of Patients at Risk for Atrial Fibrillation Recurrence After Pulmonary Vein Isolation

INTRODUCTION: Predicting which patients will be free from atrial fibrillation (AF) after pulmonary vein isolation (PVI) remains challenging. Clinical risk prediction scores show modest ability to identify patients at risk for AF recurrence after PVI. B-type natriuretic peptide (BNP) is associated with risk for incident and recurrent AF but is not currently included in existing AF risk scores. We sought to evaluate the incremental benefit of adding preoperative BNP to existing risk scores for predicting AF recurrence during the 6 months after PVI. METHODS: One hundred sixty-one patients with paroxysmal or persistent AF underwent an index PVI procedure between 2010 and 2013; 77 patients (48%) had late AF recurrence after PVI ( \u3e 3 months post-PVI) over the 6-month follow-up period. RESULTS: A BNP greater than or equal to 100 pg/dL (P = 0.01) and AF recurrence within 3 months after PVI (P \u3c 0.001) were associated with late AF recurrence in multivariate analyses. Addition of BNP to existing clinical risk scores significantly improved the areas under the curve for each score, with an integrated discrimination improvement of 0.08 (P = 0.001) and a net reclassification improvement of 60% (P = 0.001) for all risk scores. CONCLUSIONS: Circulating BNP levels are independently associated with late AF recurrence after PVI. Inclusion of BNP significantly improves the discriminative ability of CHADS2, CHA2DS2-VASc, R2CHADS2, and the HATCH score in predicting clinically significant, late AF recurrence after PVI and should be incorporated in decision-making algorithms for management of AF. B-R2CHADS2 is the best score model for prediction of late AF recurrence

Charge-changing interactions probing point-proton radii of nuclei

The question of whether charge-changing interactions can be used to probe point-proton radii of nuclei remains unanswered. Charge-changing cross sections, σcc, were systematically investigated using stable and unstable nuclear beams of intermediateenergy. The ratios of the experimental σcc values to the calculated ones obtained from a phenomenological Glauber-type model analysis are found to be nearly constant in a broad range of Z/N for light neutron-rich nuclei. This enables the determination of density distributions, i.e., the radii of protons tightly bound in nuclei. To test the applicability of the present method to all nuclei in the nuclear chart, extensive measurements were performed for medium-mass nuclei ranging from Z = 18 to 32. The present study suggests the potential capability of a new experimental approach for exploring exotic nuclei