The Egyptian Heart Journal (Dec 2016)

A new score for detection of early cardioversion using intravenous amiodarone in recent onset atrial fibrillation

  • Hisham Samir Roshdy,
  • Tarek Ahmed Naguib,
  • Mohamed Abdalla Elthalawi

DOI
https://doi.org/10.1016/j.ehj.2016.04.002
Journal volume & issue
Vol. 68, no. 4
pp. 245 – 252

Abstract

Read online

Background: Amiodarone is the only available intravenous antiarrhythmic medication in Egypt used in acute AF cardioversion. Cardioversion using IV amiodarone takes 6–8 h, and can be as late as 16 h. The aim of this study was to identify the clinical factors that are most associated with early (<8 h) successful pharmacological cardioversion of AF, and use them to construct a weighted scoring system, that can help in deciding which patient to start with electric cardioversion to reduce time and cost of hospital stay. Methods: The study included 83 consecutive patients; with first attack, recent onset AF lasting less than 48 h. The patients were divided into a study group (60 patients), and a validation group (23 patients). The study group patients were divided into Group A (cardioverted in less than 480 min), and group B (cardioverted at 480 min or more), and different clinical and echocardiographic data were collected and compared between the two groups. Relevant variables were entered in forward binary logistic regression analysis, and weighted score was constructed. The score was validated on the validation group. Results: A 7 variable scoring system was constructed as follows: LA diameter <3.35 cm 6 points, no significant MR 4 points, no history of DM 3 points, mean BP on presentation below 95 mmHg 3 points, presentation before 225 min of onset of symptoms 2 points, no history hypertension 1 point and no diastolic dysfunction 1 point, with final total score = 20 points. A ROC analysis was performed for the scored patients showing that all patients scoring 12 points or more are most likely to convert early with a sensitivity of 89.5% and a specificity of 92.7%, P < 0.0001. Score validation revealed sensitivity, specificity, and accuracy for detection of early cardioversion of 80%, 88% and 83%, P = 0.006 respectively. Conclusion: The current study suggested a weighted scoring system, to predict the time to cardioversion in patients with recent onset first presentation with atrial fibrillation.

Keywords