Doh Chang Yoon, Phan Francis, Dalouk Khidir, Raitt Merritt, Zarraga Ignatius G, Jessel Peter M
Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
J Cardiovasc Electrophysiol. 2025 Aug 13. doi: 10.1111/jce.70057.
Risk factors for recurrence of atrial arrhythmia following first direct-current cardioversion (DCCV) is not well understood. Therefore, we created a clinical predictive risk score for recurrence after the first DCCV in AFL.
Individuals with atrial arrhythmia who underwent DCCV were prospectively enrolled in our Veterans Affairs EP database (2002-2016). Time to recurrence in AF versus AFL was compared using Kaplan-Meier analysis and log-rank test. The AFL cohort was divided into derivation (60%) and validation (40%) cohorts. Multivariable Cox proportional hazards (CPH) model was used to identify covariates associated with increased hazards of recurrence (HR, 95% CI). The REAL-PDX risk score was created and tested in the AFL validation cohort.
There were 860 individuals with atrial arrhythmias who underwent their first-time DCCV. The median time to recurrence was 3.4 months (95% CI 2.6-4.7) in the AF cohort (n = 572), and 1.7 years (1.4-2.2) in the AFL cohort (n = 288). The CPH analysis of the AFL derivation cohort (n = 176) revealed that CKD (HR 2.42; 95% CI 1.41-4.14), every 1 year of older age (1.03; 1.01-1.06), LA dilation (1.60; 1.00-2.55; p < 0.05), and > 1 year since diagnosis (2.10; 1.22-3.61) were independently associated with increased risk of recurrence. BMI, OSA, hypertension, cerebrovascular disease, COPD, and heart failure did not affect the hazards of recurrence. REAL-PDX risk score (REnal disease, Age ≥ 65, LA dilation, Prior DX) incorporated one point for each factor. REAL-PDX stratified by ≥ 3 versus < 3 in the AFL validation cohort (n = 112) showed significantly shorter median time to recurrence (125 vs. 800 days; p < 0.001) and higher risk of recurrence of atrial arrhythmia (3.74; 1.93-7.24).
This simple REAL-PDX risk score allows prediction of higher risk of recurrence, which can help guide continued anticoagulation, early cavotricuspid isthmus ablation, or perhaps pulmonary vein isolation.
首次直流电复律（DCCV）后房性心律失常复发的危险因素尚未完全明确。因此，我们创建了一个临床预测风险评分，用于预测首次DCCV治疗房扑（AFL）后复发的风险。
将接受DCCV治疗的房性心律失常患者前瞻性纳入我们的退伍军人事务部电生理数据库（2002 - 2016年）。使用Kaplan - Meier分析和对数秩检验比较房颤（AF）与房扑患者的复发时间。将房扑队列分为推导队列（60%）和验证队列（40%）。采用多变量Cox比例风险（CPH）模型确定与复发风险增加相关的协变量（HR，95%CI）。创建REAL - PDX风险评分并在房扑验证队列中进行测试。
共有860例房性心律失常患者接受了首次DCCV治疗。房颤队列（n = 572）的复发中位时间为3.4个月（95%CI 2.6 - 4.7），房扑队列（n = 288）为1.7年（1.4 - 2.2）。对房扑推导队列（n = 176）的CPH分析显示，慢性肾脏病（CKD）（HR 2.42；95%CI 1.41 - 4.14）、每增加1岁（1.03；1.01 - 1.06）、左房扩大（1.60；1.00 - 2.55；p < 0.05）以及诊断后>1年（2.10；1.22 - 3.61）与复发风险增加独立相关。体重指数、阻塞性睡眠呼吸暂停、高血压、脑血管疾病、慢性阻塞性肺疾病和心力衰竭不影响复发风险。REAL - PDX风险评分（肾脏疾病、年龄≥65岁、左房扩大、既往诊断）每个因素计1分。在房扑验证队列（n = 112）中，按≥3分与<3分分层的REAL - PDX显示，复发中位时间显著缩短（125天对800天；p < 0.001），房性心律失常复发风险更高（3.74；1.93 - 7.24）。
这个简单的REAL - PDX风险评分能够预测较高的复发风险，有助于指导持续抗凝、早期三尖瓣峡部消融或可能的肺静脉隔离。
