Europace Advance Access originally published online on March 16, 2006
Europace 2006 8(4):297-301; doi:10.1093/europace/eul010
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CARDIOVERSION
A simple point score system for predicting the efficacy of external rectilinear biphasic cardioversion for persistent atrial fibrillation
Department of Cardiology, Postgraduate Medical SchoolGrochowski HospitalGrenadierow 51/59 Street, 04-073 Warsaw Poland
Aims 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).
Methods and 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, 
2 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.
Conclusion A simple point score system is useful in prediction of successful initial RLB energy for DC of AF.
Key Words: Persistent atrial fibrillation, Cardioversion, Rectilinear biphasic waveform, Initial energy, Point score system
* Corresponding author. Tel/fax: +48 22 8109802. E-mail address: smstec{at}wp.pl
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