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. 2024 Mar 3;13(5):1470.
doi: 10.3390/jcm13051470.

Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation When Less Could Be More?

Marco Valerio Mariani  1 , Nicola Pierucci  1 , Sara Trivigno  1 , Pietro Cipollone  1 , Agostino Piro  1 , Cristina Chimenti  1 , Domenico Giovanni Della Rocca  2 , Fabio Miraldi  3 , Carmine Dario Vizza  1 , Carlo Lavalle  1
Affiliations

Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation When Less Could Be More?

Marco Valerio Mariani et al. J Clin Med. .

Abstract

Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well known. Objective: To develop and validate a score to determine the probability of SCV to SR in patients presenting to the ED with hemodynamically stable, symptomatic AF. Methods: This retrospective, observational study enrolled consecutive patients admitted with AF to the ED. Variables associated to SCV during a 6 h "wait-and-see" approach were used to develop and validate a score to determine the probability of SCV to SR in AF patients. The study was divided in two phases: (1) score development and (2) validation of the predictive score. Results: Out of 748 eligible patients, 446 patients were included in the derivation cohort, whereas 302 patients were included in the validation cohort. In the derivation cohort, based on multivariable logistic analysis, a probability score weight was developed including: previous SCV (3 points), AF-related symptom duration < 24 h (5 points), age ≥ 65 years (3 points) and female sex (2 points). The score allowed us to divide patients in three groups based on the probability of SCV to SR during the 6 h observation period. The probability prediction model showed an area under the curve (AUC) of 0.707 and 0.701 in the derivation and validation cohorts, respectively. Conclusions: The proposed score allowed us to predict SCV probability with good accuracy and may help physicians in tailoring AF management in an effective and timely manner.

Keywords: atrial fibrillation; emergency department; spontaneous conversion.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Observed incidence of spontaneous conversion across low (0 to 5), intermediate (6 to 9) and high (10 to 13) probability categories for spontaneous conversion (SCV) in the derivation cohort (superior panel) and the validation cohort (inferior panel). Numbers and percentages of patients experiencing SCV are shown, with p-values for comparisons of SCV rates among different groups. The symbol * indicates a p-value < 0.05, whereas the symbol § indicates a p-value ≥ 0.05.
Figure 2
Figure 2
Receiver-operating characteristic (ROC) curve of probability score as a diagnostic test for the prediction of spontaneous conversion in the derivation cohort (superior panel) and the validation cohort (inferior panel). AUC: area under the curve.
See this image and copyright information in PMC

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