Niederdöckl Jan Daniel, Simon Alexander, Buchtele Nina, Schütz Nikola, Cacioppo Filippo, Oppenauer Julia, Gupta Sophie, Lutnik Martin, Schnaubelt Sebastian, Spiel Alexander, Roth Dominik, Wimbauer Fritz, Fegers-Wustrow Isabel, Esefeld Katrin, Halle Martin, Scharhag Jürgen, Laschitz Thomas, Herkner Harald, Domanovits Hans, Schwameis Michael
Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria.
Zentrale Notaufnahme, Klinik Ottakring, 1160 Vienna, Austria.
J Pers Med. 2022 Mar 30;12(4):544. doi: 10.3390/jpm12040544.
Background: Modern personalised medicine requires patient-tailored decisions. This is particularly important when considering pharmacological cardioversion for the acute treatment of haemodynamically stable atrial fibrillation and atrial flutter in a shared decision-making process. We aimed to develop and validate a predictive model to estimate the individual probability of successful pharmacological cardioversion using different intravenous antiarrhythmic agents. Methods: We analysed data from a prospective atrial fibrillation registry comprising 3053 cases of first-detected or recurrent haemodynamically stable, non-permanent, symptomatic atrial fibrillation presenting to an Austrian academic emergency department between January 2012 and December 2017. Using multivariable analysis, a prediction score was developed and externally validated. The clinical utility of the score was assessed using decision curve analysis. Results: A total of 1528 cases were included in the development cohort (median age 69 years, IQR 58−76; 43.9% female), and 1525 cases were included in the validation cohort (median age 68 years, IQR (58−75); 39.5% female). Finally, 421 cases were available for score development and 330 cases for score validation The weighted score included atrial flutter (8 points), duration of symptoms associated with AF (<24 h; 8 points), absence of previous electrical cardioversion (10 points), and the specific intravenous antiarrhythmic drug (amiodarone 10 points, vernakalant 11 points, ibutilide 13 points). The final score, the “Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) score,” showed good calibration (R2 = 0.955 and R2 = 0.954) and discrimination in both sets (c-indices: 0.68 and 0.66) and net clinical benefit. Conclusions: A predictive model was developed to estimate the success of intravenous pharmacological cardioversion using different antiarrhythmic agents in a cohort of patients with haemodynamically stable, non-permanent, symptomatic atrial fibrillation. External temporal validation confirmed good calibration, discrimination, and clinical usefulness. The SIC-AF score may help patients and physicians jointly decide on the appropriate treatment strategy for acute symptomatic atrial fibrillation. Registration: NCT03272620.
现代个性化医疗需要针对患者量身定制决策。在共同决策过程中考虑对血流动力学稳定的心房颤动和心房扑动进行药物复律的急性治疗时，这一点尤为重要。我们旨在开发并验证一种预测模型，以估计使用不同静脉抗心律失常药物进行药物复律成功的个体概率。
我们分析了来自前瞻性心房颤动登记处的数据，该登记处包括2012年1月至2017年12月期间在奥地利一家学术急诊科首次检测到或复发的3053例血流动力学稳定、非永久性、有症状的心房颤动病例。使用多变量分析，开发了一个预测评分并进行外部验证。使用决策曲线分析评估该评分的临床实用性。
共有1528例病例纳入开发队列（中位年龄69岁，四分位间距58 - 76岁；43.9%为女性），1525例病例纳入验证队列（中位年龄68岁，四分位间距(58 - 75)岁；39.5%为女性）。最后，421例病例可用于评分开发，330例病例可用于评分验证。加权评分包括心房扑动（8分）、与房颤相关的症状持续时间（<24小时；8分）、既往无电复律（10分）以及特定的静脉抗心律失常药物（胺碘酮10分、维纳卡兰11分、伊布利特13分）。最终评分，即“心房颤动静脉复律成功（SIC - AF）评分”，在两组中均显示出良好的校准（R2 = 0.955和R2 = 0.954）和区分度（c指数：0.68和0.66）以及净临床获益。
开发了一种预测模型，以估计在血流动力学稳定、非永久性、有症状的心房颤动患者队列中使用不同抗心律失常药物进行静脉药物复律的成功率。外部时间验证证实了良好的校准、区分度和临床实用性。SIC - AF评分可能有助于患者和医生共同决定急性症状性心房颤动的合适治疗策略。
NCT03272620。
