SUCCESS score for success rate in atrial fibrillation ablation: Does one size fit all?

With great interest, we read the article written by Jud et al. (1). Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice, and catheter ablation is used to restore sinus rhythm in highly symptomatic patients that fail to respond to antiarrhythmic drug therapy. In the study conducted by Jud et al. (1), APPLE score was superior to both well-known thromboembolic risk scores (CHADS2 and CHA2 DS2 -VASc) for predicting AF recurrence rates post catheter ablation. Moreover, the authors devised a new risk score, the SUCCESS score, by adding previous ablations to the APPLE score with a subsequent improvement in c-statics (1). We agree with the authors that there is an urgent need for the better identification of candidates for catheter ablation and that till now, no risk score has included imagistic parameters despite increasing body of evidence linking left atrial (LA) enlargement to both increased thromboembolic risk and poor ablation outcomes (2).