Jan Niederdöckl1, Alexander Simon2, Filippo Cacioppo1, Nina Buchtele3, Anne Merrelaar1, Nikola Schütz1, Sebastian Schnaubelt1, Alexander O Spiel4, Dominik Roth1, Christian Schörgenhofer5, Harald Herkner6, Hans Domanovits1, Michael Schwameis1. 1. Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. 2. Zentrale Notaufnahme, Wilhelminenspital, Montleartstr.37, 1160 Vienna, Austria. 3. Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. 4. Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; Zentrale Notaufnahme, Wilhelminenspital, Montleartstr.37, 1160 Vienna, Austria. 5. Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. 6. Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Electronic address: harald.herkner@meduniwien.ac.at.
Abstract
BACKGROUND: The optimal management of patients presenting to the Emergency Department with hemodynamically stable symptomatic atrial fibrillation remains unclear. We aimed to develop and validate an easy-to-use score to predict the individual probability of spontaneous conversion to sinus rhythm in these patients METHODS: This retrospective cohort study analyzed 2426 cases of first-detected or recurrent hemodynamically stable non-permanent symptomatic atrial fibrillation documented between January 2011 and January 2019 in an Austrian academic Emergency Department atrial fibrillation registry. Multivariable analysis was used to develop and validate a prediction score for spontaneous conversion to sinus rhythm during Emergency Department visit. Clinical usefulness of the score was assessed using decision curve analysis RESULTS: 1420 cases were included in the derivation cohort (68years, 57-76; 43% female), 1006 cases were included in the validation cohort (69years, 58-76; 47% female). Six variables independently predicted spontaneous conversion. These included: duration of atrial fibrillation symptoms (<24hours), lack of prior cardioversion history, heart rate at admission (>125bpm), potassium replacement at K+ level ≤3.9mmol/l, NT-proBNP (<1300pg/ml) and lactate dehydrogenase level (<200U/l). A risk score weight was assigned to each variable allowing classification into low (0-2), medium (3-5) and moderate (6-8) probability of spontaneous conversion. The final score showed good calibration (p=0.44 and 0.40) and discrimination in both cohorts (c-indices: 0.74 and 0.67) and clinical net benefit CONCLUSION: The ReSinus score, which predicts spontaneous conversion to sinus rhythm, was developed and validated in a large cohort of patients with hemodynamically stable non-permanent symptomatic atrial fibrillation and showed good calibration, discrimination and usefulness REGISTRATION: NCT03272620.
BACKGROUND: The optimal management of patients presenting to the Emergency Department with hemodynamically stable symptomatic atrial fibrillation remains unclear. We aimed to develop and validate an easy-to-use score to predict the individual probability of spontaneous conversion to sinus rhythm in these patients METHODS: This retrospective cohort study analyzed 2426 cases of first-detected or recurrent hemodynamically stable non-permanent symptomatic atrial fibrillation documented between January 2011 and January 2019 in an Austrian academic Emergency Department atrial fibrillation registry. Multivariable analysis was used to develop and validate a prediction score for spontaneous conversion to sinus rhythm during Emergency Department visit. Clinical usefulness of the score was assessed using decision curve analysis RESULTS: 1420 cases were included in the derivation cohort (68years, 57-76; 43% female), 1006 cases were included in the validation cohort (69years, 58-76; 47% female). Six variables independently predicted spontaneous conversion. These included: duration of atrial fibrillation symptoms (<24hours), lack of prior cardioversion history, heart rate at admission (>125bpm), potassium replacement at K+ level ≤3.9mmol/l, NT-proBNP (<1300pg/ml) and lactate dehydrogenase level (<200U/l). A risk score weight was assigned to each variable allowing classification into low (0-2), medium (3-5) and moderate (6-8) probability of spontaneous conversion. The final score showed good calibration (p=0.44 and 0.40) and discrimination in both cohorts (c-indices: 0.74 and 0.67) and clinical net benefit CONCLUSION: The ReSinus score, which predicts spontaneous conversion to sinus rhythm, was developed and validated in a large cohort of patients with hemodynamically stable non-permanent symptomatic atrial fibrillation and showed good calibration, discrimination and usefulness REGISTRATION: NCT03272620.
Authors: Jan Niederdöckl; Julia Oppenauer; Sebastian Schnaubelt; Filippo Cacioppo; Nina Buchtele; Alexandra-Maria Warenits; Roberta Laggner; Nikola Schütz; Magdalena S Bögl; Gerhard Ruzicka; Sophie Gupta; Martin Lutnik; Safoura Sheikh Rezaei; Michael Wolzt; Harald Herkner; Hans Domanovits; Anton N Laggner; Michael Schwameis; Ziad Hijazi Journal: Front Med (Lausanne) Date: 2022-06-27
Authors: Sophie Gupta; Martin Lutnik; Jan Niederdöckl; Sebastian Schnaubelt Journal: Int J Environ Res Public Health Date: 2022-04-15 Impact factor: 4.614
Authors: 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 Journal: J Pers Med Date: 2022-03-30
Authors: Jordi Heijman; Henry Sutanto; Harry J G M Crijns; Stanley Nattel; Natalia A Trayanova Journal: Cardiovasc Res Date: 2021-06-16 Impact factor: 10.787