A simple point score system for predicting the efficacy of external rectilinear biphasic cardioversion for persistent atrial fibrillation.
OBJECTIVE
To develop a simple point score system that can accurately predict the optimal energy of initial rectilinear biphasic (RLB) waveform shock for cardioversion (DC) of persistent atrial fibrillation (AF).


RESULTS
Data from 302 consecutive patients with AF who underwent a step-up protocol of sequential shocks of 50 J-from 1 up to 2 J/kg-200 J of RLB waveform DC were prospectively examined. Using a logistic regression model, three variables independently predicted the need for 2 J/kg shocks: AF duration > 7 months, previous DC, and increased left atrial (LA) diameter > 4.5 cm. A simplified point score system (REBICAF score) that spans from 0 to 4 was developed. The score gives two points for AF duration > 7 months and one point for previous DC or LA diameter > 4.5 cm. The area under the receiver operator curve (ROC) of the proposed score for predicting the need for 2 J/kg shock was 0.84. There was a progressive increase in the need for 1 J/kg, 2 J/kg, and 200 J as the point score increased (P < 0.001, chi2 test for trend). More than 90% cumulative success rate was achieved in the low- (0-1), intermediate- (2), and high-REBICAF (3-4) score subgroups with 1 J/kg, 2 J/kg, and 200 J RLB shocks, respectively.


CONCLUSIONS
A simple point score system is useful in prediction of successful initial RLB energy for DC of AF.
Stec
Sebastian
S
Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Grenadierow 51/59 Street, 04-073 Warsaw, Poland. smstec@wp.pl
Gorecki
Aleksander
A
Zaborska
Beata
B
Kulakowski
Piotr
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy*; D016009:Chi-Square Distribution; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome