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Europace Advance Access published online on March 16, 2006
Europace, doi:10.1093/europace/eul010
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© The European Society of Cardiology 2006. All rights reserved
Received May 6, 2005
Accepted January 15, 2006

Article

A simple point score system for predicting the efficacy of external rectilinear biphasic cardioversion for persistent atrial fibrillation

Sebastian Stec 1 *, Aleksander Gorecki 1, Beata Zaborska 1, and Piotr Kulakowski 1

1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Grenadierow 51/59 Street, 04-073 Warsaw, Poland

* To whom correspondence should be addressed.
Sebastian Stec, E-mail: smstec{at}wp.pl


  Abstract

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, {chi}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.

Keywords: Persistent atrial fibrillation; Cardioversion; Rectilinear biphasic waveform; Initial energy; Point score system.
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J. M. Alegret, X. Vinolas, J. Sagrista, A. Hernandez-Madrid, L. Perez, X. Sabate, L. Mont, A. Medina, and on behalf of the REVERSE Study Investigators
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Europace, October 1, 2007; 9(10): 942 - 946.
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