Personalized assessment of the cumulative complication risk of the atrial fibrillation ablation track: The AF-TRACK calculator

BACKGROUND: Atrial fibrillation (AF) ablation strategy is associated with a non-negligible risk of complications and often requires repeat procedures (AF ablation track), implying repetitive exposure to procedural risk. OBJECTIVE: The purpose of this study was to develop and validate a model to estimate individualized cumulative risk of complications in patients undergoing the AF ablation track (Atrial Fibrillation TRAck Complication risK [AF-TRACK] calculator). METHODS: The model was derived from a multicenter cohort including 3762 AF ablation procedures in 2943 patients. A first regression model was fitted to predict the propensity for repeat ablation. The AF-TRACK calculator computed the risk of AF ablation track complications, considering the propensity for repeat ablation. Internal (cross-validation) and external (independent cohort) validation were assessed for discrimination capacity (area under the curve [AUC]) and goodness of fit (Hosmer-Lemeshow [HL] test). RESULTS: Complications (N = 111) occurred in 3.7% of patients (2.9% of procedures). Predictors included female sex, heart failure, sleep apnea syndrome, and repeat procedures. The model showed fair discrimination capacity to predict complications (AUC 0.61 [0.55–0.67]) and likelihood of repeat procedure (AUC 0.62 [0.60–0.64]), with good calibration (HL χ(2) 12.5; P = .13). The model maintained adequate discrimination capacity (AUC 0.67 [0.57–0.77]) and calibration (HL χ(2) 5.6; P = .23) in the external validation cohort. The validated model was used to create the Web-based AF-TRACK calculator. CONCLUSION: The proposed risk model provides individualized estimates of the cumulative risk of complications of undergoing the AF ablation track. The AF-TRACK calculator is a validated, easy-to-use, Web-based clinical tool to calibrate the risk-to-benefit ratio of this treatment strategy.