To our knowledge, this is the first study to investigate the impact of ABC stroke score on the late recurrence of PAF following radiofrequency catheter ablation. The key findings of our study include the novel exploration of the predictive value of the ABC stroke score in assessing recurrence after AF ablation. Specifically, an ABC stroke score of ≥ 6.4 indicated increased risk of recurrence following RFCA of AF.

There is a gradual increase in the incidence of AF, posing clinical hazards that primarily include heart failure and stroke [1]. Despite advancements in catheter ablation technology and expertise there still remains a certain recurrence rate after RFCA [2]. Consequently, the latest guidelines from the European Society of Cardiology recommend evaluating not only the procedural risk but also the risk factors for AF recurrence after catheter ablation prior to the procedure. Previous studies have indicated that age, diabetes mellitus, biological indicators, and left atrial size are individual risk factors for the late recurrence after RFCA. However, these independent risk factors exhibit a compounding effect and interact with each other. Therefore, the combination of multiple related risk factors into a single quantitative risk score system may provide a more reliable assessment of the outcome following AF ablation. Presently, the commonly used risk scoring systems for AF include APPLE [6], ATLAS [7], BASE-AF2 [8], CAAP-AF [9], CHA2DS2-VASc [10], and MB-LATE [11], among others. A study conducted by Mark compared the efficacy of various scoring systems in predicting AF recurrence after catheter ablation [4]. The results indicated that these scoring systems have low predictive value for recurrence (area under curve [AUC] 0.553–0.669), although statistically significant. In our study, we observed, that the ABC stroke score had a predictive value for AF recurrence after RFCA, demonstrating a high diagnostic efficacy (AUC 0.742). The ABC stroke score is a new stroke risk score established by Hijazi et al. from a large cohort of 14,701 patients in the ARISTOTLE trial. It combines cardiac biological indicators such as NT-ProBNP and troponin with clinical indicators of age and stroke history, which are not included concurrently in other scoring systems. NT-proBNP and troponin are used as cardiac biomarkers within the ABC stroke score, representing left ventricular hypertrophy and myocardial injury associated with elevated pressure and structural remodeling of the left atrium [12].

Some studies have suggested that biomarkers such as NT-proBNP and troponin are independently associated with AF recurrence [13]. However, upon analysis, we found that NT-proBNP and troponin were not risk factors for late recurrence of AF after catheter ablation (P > 0.05). Additionally, contrary to other findings, age was not identified as a risk factor for late recurrence of AF after catheter ablation. This difference could be attributed to the relatively lower age of the population in this study, with participants ranging from 56 to 68 years in age, with an average age of 62 years. Furthermore, the efficacy and safety of RFCA in patients with a history of stroke have been reported to be comparable to those without such a history [14, 15]. In this study we did not find an association between a history of stroke and late recurrence of AF, also no association was found between a history of stroke and late recurrence of AF after catheter ablation. The ABC stroke score utilized in our study, which combines the above-mentioned indicators, provides a comprehensive evaluation of the clinical characteristics of patients and demonstrates predictive value in AF recurrence after catheter ablation. This is in contrast to single clinical indicators or biological markers, which exhibit weak early warning signs for late recurrence. Importantly, the parameters included in the ABC stroke scoring system are widely used and highly operable.

Studies have shown that early recurrence of AF is a strong predictor of late recurrence [16]. The inflammatory response following cellular injury during catheter ablation induces abnormal conduction in atrial tissue and increases the susceptibility to arrhythmia. Additionally, the recovery of pulmonary vein conduction is a significant mechanism contributing to early recurrence, substantially elevating the likelihood of late recurrence [17]. This process may also reshape the atrial matrix by increasing sympathetic activation and reducing the vagus nerve activity thus altering the autonomic nervous system. Atrial remodeling, as a result, could generate new AF trigger foci, ultimately leading to ablation failure [18, 19]. The findings of this study substantiate the notion that early recurrence of AF stands as an independent risk factor for late recurrence.

Effective assessment of the risk of late recurrence of AF after RFCA is crucial for guiding treatment decisions for doctors and patients. The ABC stroke scoring system, known for its efficacy in evaluating stroke risk in patients with AF, can be employed to stratify the risk of late recurrence following AF ablation. The indicators within the ABC stroke scoring system are easy to obtain clinically and are easy to implement. It is worthwhile to further investigate whether controlling the factors incorporated in the ABC stroke scoring system, such as prevention of stroke and the reduction of preoperative NT-proBNP and troponin levels, can contribute to a reduction in late recurrence.

This study was a retrospective, single-center, limited number of patients study. Patients with organic heart disease such as cardiomyopathy and severe valvular disease, which are known to be associated with a higher likelihood of developing AF were excluded. The ABC stroke scoring system initially designed to evaluate stroke risk in patients with AF primarily emphasizes factors correlated with stroke. However, the value of other clinical indicators and biological markers in predicting late recurrence of AF after RFCA cannot be ignored.