A Simplified Scoring System to Predict Progression of Clinical Atrial Fibrillation from Atrial High-Rate Episodes

Background Clinical atrial fibrillation (AF) progression from atrial high-rate episodes (AHRE) poses significant clinical risks. Objective This study aimed to develop a scoring system to predict clinical AF progression. Methods Patients with documented AHRE but no prior clinical AF were enrolled. A simplified scoring system was developed to predict subsequent clinical AF progression using multivariable logistic regression. Results Among 209 patients with documented AHRE and no prior clinical AF, 37 (17.7%) progressed to clinically documented AF confirmed by 12-lead electrocardiography. Multivariable analysis identified three independent predictors of progression: CHA 2 DS 2 -VASc score >5 (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.4-6.6), left atrial (LA) diameter >46 mm (OR 4.1, 95% CI 1.8-9.2), and longer AHRE duration. Based on these variables, we developed a simplified risk score assigning 1 point for CHA 2 DS 2 -VASc >5, 1 point for LA diameter >46 mm, and 1, 2, or 3 points for AHRE duration >6 minutes, >6 hours, or >24 hours, respectively. The total score ranged from 0 to 5 and showed good discriminative performance, with an area under curve of 0.84 (95% CI 0.7-0.9). A score ≥3 identified patients with an observed clinical AF progression risk of approximately 60% or higher. Over a mean follow-up of 5.5±4.3 years, progression was associated with worse clinical outcomes. Conclusions This simplified scoring system showed high predictive value, effectively stratifying patients by AF progression risk and offering a clinically applicable tool for identifying high-risk individuals.