Objective quality assessment of atrial fibrillation ablation: A novel scoring system

health-care processes and overall patient outcomes. 1 However, these critical evaluations have been lacking in the field of interventional cardiac electrophysiology and in the assessment of catheter ablation for atrial fibrillation (CAAF) in particular. The clinical success of CAAF, the most common ablation procedure performed worldwide, is currently reported in terms of atrial fibrillation (AF) recurrence rates, an assessment strategy with considerable limitations. Since recognition of AF recurrence is largely based on the presence of symptoms and as recurrences are frequently asymptomatic, 2 this strategy can substantially underestimate the true incidence of postablation AF. Even when noninvasive monitoring is routinely used after ablation, the sensitivity for the detection of asymptomatic AF recurrences depends on the protocol used, with more aggressive arrhythmia surveillance certain to identify higher rates of recurrence. 3 Furthermore, the definition of AF burden (symptomatic and asymptomatic) used to define recurrence varies and there are discrepancies as to whether a requirement for antiarrhythmic drugs is considered separately from maintenance of sinus rhythm without adjuvant pharmacotherapy. 4 As a result, there are wide variations in reported recurrence rates after CAAF among centers and the factors accounting for these differences have not been systematically delineated. In addition, and perhaps most importantly, reported success rates do not account for procedural safety, precluding meaningful comparisons between different techniques. The appraisal of CAAF requires a more objective evaluation that combines data on the quality of lesion delivery, complication rates, and clinical outcomes. To develop a more comprehensive, less biased criterion to assess the quality of CAAF and standardize comparisons between ablation strategies, we devised a novel quantitative scoring system based on more objective measures of the ablation procedure and a weighted assessment of procedurerelated complications, which we have termed the AF ablation (AFA) score.