Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score
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 devel...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/12/4/544 |
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| author | Jan Daniel Niederdöckl Alexander Simon Nina Buchtele Nikola Schütz Filippo Cacioppo Julia Oppenauer Sophie Gupta Martin Lutnik Sebastian Schnaubelt Alexander Spiel Dominik Roth Fritz Wimbauer Isabel Fegers-Wustrow Katrin Esefeld Martin Halle Jürgen Scharhag Thomas Laschitz Harald Herkner Hans Domanovits Michael Schwameis |
| author_facet | Jan Daniel Niederdöckl Alexander Simon Nina Buchtele Nikola Schütz Filippo Cacioppo Julia Oppenauer Sophie Gupta Martin Lutnik Sebastian Schnaubelt Alexander Spiel Dominik Roth Fritz Wimbauer Isabel Fegers-Wustrow Katrin Esefeld Martin Halle Jürgen Scharhag Thomas Laschitz Harald Herkner Hans Domanovits Michael Schwameis |
| author_sort | Jan Daniel Niederdöckl |
| collection | DOAJ |
| description | 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 (R<sup>2</sup> = 0.955 and R<sup>2</sup> = 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. |
| first_indexed | 2024-03-09T13:26:54Z |
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| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T13:26:54Z |
| publishDate | 2022-03-01 |
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| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-0bedb7255bfa40ad85d73fbab1c9b4372023-11-30T21:22:34ZengMDPI AGJournal of Personalized Medicine2075-44262022-03-0112454410.3390/jpm12040544Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) ScoreJan Daniel Niederdöckl0Alexander Simon1Nina Buchtele2Nikola Schütz3Filippo Cacioppo4Julia Oppenauer5Sophie Gupta6Martin Lutnik7Sebastian Schnaubelt8Alexander Spiel9Dominik Roth10Fritz Wimbauer11Isabel Fegers-Wustrow12Katrin Esefeld13Martin Halle14Jürgen Scharhag15Thomas Laschitz16Harald Herkner17Hans Domanovits18Michael Schwameis19Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaZentrale Notaufnahme, Klinik Ottakring, 1160 Vienna, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaClinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, GermanyClinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, GermanyClinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, GermanyClinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, GermanyDepartment of Sports Medicine, Exercise Physiology and Prevention, Institute of Sport Science, Centre for Sport Science and University Sports, University of Vienna, 1150 Vienna, AustriaDepartment of Obstetrics and Gynecology, Landesklinikum Korneuburg, 2102 Korneuburg, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaBackground: 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 (R<sup>2</sup> = 0.955 and R<sup>2</sup> = 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.https://www.mdpi.com/2075-4426/12/4/544symptomatic atrial fibrillationintravenous pharmacological cardioversionpredictionscoredevelopmentvalidation |
| spellingShingle | Jan Daniel Niederdöckl Alexander Simon Nina Buchtele Nikola Schütz Filippo Cacioppo Julia Oppenauer Sophie Gupta Martin Lutnik Sebastian Schnaubelt Alexander Spiel Dominik Roth Fritz Wimbauer Isabel Fegers-Wustrow Katrin Esefeld Martin Halle Jürgen Scharhag Thomas Laschitz Harald Herkner Hans Domanovits Michael Schwameis Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score Journal of Personalized Medicine symptomatic atrial fibrillation intravenous pharmacological cardioversion prediction score development validation |
| title | Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score |
| title_full | Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score |
| title_fullStr | Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score |
| title_full_unstemmed | Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score |
| title_short | Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score |
| title_sort | prediction of successful pharmacological cardioversion in acute symptomatic atrial fibrillation the successful intravenous cardioversion for atrial fibrillation sic af score |
| topic | symptomatic atrial fibrillation intravenous pharmacological cardioversion prediction score development validation |
| url | https://www.mdpi.com/2075-4426/12/4/544 |
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