A Prognostic Score To Predict Atrial fibrillation Recurrence After External Electrical Cardioversion—SLAC Score

Abstract

Introduction: Atrial fibrillation (AF) recurrence after a successful external electrical cardioversion (ECV) is common. Assessing an individual's risk of AF recurrence is a critical part of the treatment plan. We aimed to develop a prognostic prediction score to predict AF recurrence in AF patients who underwent successful ECV. Methods: A retrospective cohort study that included AF patients who underwent successful ECV was conducted with a primary outcome of AF recurrence at 6 months. Logistic regression analysis was done to identify variables, and a prognostic prediction score was created and internally validated. Results: Four prognostic predictors were identified, including the type of AF, persistent AF (1 point) and long-standing persistent AF (4 points), previous cardioversion (1 point), stroke/transient ischemic attack (3 points), and left atrial volume index ≥40 mL/m 2 (6 points). The total score of 14 was further divided into 3 risk groups; low-risk (0-2 points), moderate-risk (3-7 points), and high-risk (8-14 points). The positive likelihood ratio for a moderate-risk patient was 2.08 (95% CI, 1.64-2.63) and for a high-risk patient was 7.90 (95% CI, 2.48-25.17). The score showed good discrimination power with the c-statistic of 0.74 (95% CI, 0.69-0.79). Conclusions: A simple prognostic prediction score for AF recurrence after successful ECV was created with a promising internally validated discrimination power. An external assessment of its usefulness as a tool to identify patients with low, moderate, and high risk for AF recurrence is warranted.

Usefulness of risk scores and predictors of atrial fibrillation recurrence after elective electrical cardioversion

“…This study highlights the prognostic impact of previously attempted cardioversion. As in other studies, prior history of ECV was an important independent predictor of recurrence (Boriani et al, 2007;Martínez-Brotóns et al, 2006;Thangjui et al, 2022).…”

“…Additionally, the post-ECV follow-up and rhythm monitoring were intermittent, which could have led to missing some recurrence cases if those would have been asymptomatic episodes. Nonetheless, our follow-up is similar to the follow-up reported in previous studies, which also did not include continuous ECG monitoring (Kornej et al, 2015;Mesquita et al, 2018;Mujović et al, 2017;Thangjui et al, 2022;Winkle et al, 2016). In spite of the existence of other clinical scores to predict post-CA and post-PCV recurrence, they could not be evaluated as we did not have the necessary data.…”

“…AF patients display a higher risk of stroke and almost twofold risk of mortality, compared to the general population (Hindricks et al, 2020;Thangjui et al, 2022). Although rhythm control had been classically considered not to bring any benefit regarding morbidity and mortality (Hagens et al, 2005;Wyse et al, 2002), recent studies highlight the relationship between a higher rate of adverse events and AF progression.…”

“…Atrial fibrillation (AF) is the most frequent arrhythmia in adults and is associated with a significant morbidity and mortality, and a decrease in quality of life (Brandes et al., 2020 ; Hindricks et al., 2020 ). AF patients display a higher risk of stroke and almost twofold risk of mortality, compared to the general population (Hindricks et al., 2020 ; Thangjui et al., 2022 ). Although rhythm control had been classically considered not to bring any benefit regarding morbidity and mortality (Hagens et al., 2005 ; Wyse et al., 2002 ), recent studies highlight the relationship between a higher rate of adverse events and AF progression.…”

“…Electrical cardioversion (ECV) is frequently used to control rhythm in AF, with an efficacy rate around 90% and a low percentage of adverse events (Pisters et al., 2012 ). Nonetheless, the recurrence of AF is common, with rates reaching up to 21% within the first month after the procedure to 60% in the following months (Nuñez‐Garcia et al., 2022 ; Thangjui et al., 2022 ; Vitali et al., 2019 ). Despite several AF relapse predictors being identified, such as non‐paroxysmal pattern, prolonged evolution time, chronic obstructive pulmonary disease (COPD), advanced age, or left atrium (LA) enlargement, the assessment of the individual risk of recurrence is still a challenge as there is no isolated parameter that allows us to reliably predict recurrence.…”