Predicting spontaneous conversion to sinus rhythm in symptomatic atrial fibrillation: The ReSinus score

Abstract

Background: The optimal management of patients presenting to the Emergency Department with hemodynamically stable symptomatic atrial fibrillation remains unclear. We aimed to develop and validate an easy-to-use score to predict the individual probability of spontaneous conversion to sinus rhythm in these patients Methods: This retrospective cohort study analyzed 2426 cases of first-detected or recurrent hemodynamically stable non-permanent symptomatic atrial fibrillation documented between January 2011 and January 2019 in an Austrian academic Emergency Department atrial fibrillation registry. Multivariable analysis was used to develop and validate a prediction score for spontaneous conversion to sinus rhythm during Emergency Department visit. Clinical usefulness of the score was assessed using decision curve analysis Results: 1420 cases were included in the derivation cohort (68years, 57-76; 43% female), 1006 cases were included in the validation cohort (69years, 58-76; 47% female). Six variables independently predicted spontaneous conversion. These included: duration of atrial fibrillation symptoms (<24hours), lack of prior cardioversion history, heart rate at admission (>125bpm), potassium replacement at K + level ≤3.9mmol/l, NT-proBNP (<1300pg/ml) and lactate dehydrogenase level (<200U/l). A risk score weight was assigned to each variable allowing classification into low (0-2), medium (3-5) and moderate (6-8) probability of spontaneous conversion. The final score showed good calibration (p=0.44 and 0.40) and discrimination in both cohorts (cindices: 0.74 and 0.67) and clinical net benefit Conclusion: The ReSinus score, which predicts spontaneous conversion to sinus rhythm, was developed and validated in a large cohort of patients with hemodynamically stable non-permanent symptomatic atrial fibrillation and showed good calibration, discrimination and usefulness Registration: NCT03272620

Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department

“…4 Thus, implementation of wait-and-watch strategies combined with scoring systems to estimate the probability of spontaneous conversion to sinus rhythm (SCV) might be an innovative approach to avoid unnecessary antiarrhythmic therapy and its potential adverse effects. 5 Moreover, evidence suggests that hypokalemia and hypomagnesemia contribute to AF development. 6,7 Thus, the administration of potassium and magnesium could be a reasonable strategy to improve SCV rates.…”

The ABC-Stroke Score Refines Stroke Risk Stratification in Patients With Atrial Fibrillation at the Emergency Department

“…The 1-year risk of stroke was calculated for each patient using both the ABC-stroke score and the CHA 2 DS 2 -VASc score, irrespective of stroke history or whether or not the patient was on anticoagulation therapy. The discriminatory capabilities of the scores were evaluated using Harrel's c-indices ( 15 ), Kaplan-Meier curves, and hazard ratios. These were applied to predefined risk classes with 0–1%, 1–2%, or >2% risk of stroke within 1 year.…”

Tratamiento de la fibrilación auricular en el servicio de urgencias: una revisión práctica de la literatura

“…Un estudio desarrolló y validó una puntuación fácil de usar para estimar la probabilidad individual de conversión espontánea a sinusal en pacientes adultos con FA sintomática no permanente hemodinámicamente estable que acuden al servicio de urgencias. El ReSinus score utiliza variables clínicas y de laboratorio de rutina (A: duración de síntomas de FA < 24 h, B: Sin CVE previa, C: FC > 125 lpm, D: potasio sérico ≤ a 3.9 mmol/l, E: NT-ProBNP < 1.300 pg/ml, F deshidrogenasa láctica < 200 U/l) para predecir la conversión espontánea a ritmo sinusal y muestra buena calibración, discriminación y evaluación clínica 50 . A pesar de la falta de validación en Latinoamérica, puede ser una herramienta útil para implementar en la práctica diaria.…”