Daniel Águila-Gordo MD, Javier Jiménez-Díaz MD, PhD, Martín Negreira-Caamaño MD, Jorge Martínez-Del Rio MD, Cristina Ruiz-Pastor MD, Ignacio Sánchez Pérez MD, Jesús Piqueras-Flores MD, PhD
{"title":"选择性电复律后房颤复发的风险评分和预测因素的有效性。","authors":"Daniel Águila-Gordo MD, Javier Jiménez-Díaz MD, PhD, Martín Negreira-Caamaño MD, Jorge Martínez-Del Rio MD, Cristina Ruiz-Pastor MD, Ignacio Sánchez Pérez MD, Jesús Piqueras-Flores MD, PhD","doi":"10.1111/anec.13095","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Electrical cardioversion (ECV) is a frequently used procedure for restoring sinus rhythm in atrial fibrillation (AF); however, the rate of recurrence is high. The identification of patients at high risk of recurrence could influence the decision-making process. The present study evaluates the predictive value of risk scores in atrial fibrillation recurrence after elective electrical cardioversion.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Unicentric, observational, and prospective study of adult patients who have undergone an elective ECV as rhythm control strategy between July 2017 and September 2022.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>From the 283 analyzed patients (mean age 63.95 ± 10.76212, 74.9% male); 99 had paroxysmal AF (35%) and 159 (59%) presented AF recurrence during a follow-up of 6 months. In patients with post-ECV AF recurrence, the period of time from diagnosis until the performance of the procedure was longer (393 ± 891 vs. 195 ± 527, <i>p</i> = .02). No paroxysmal AF (71.3% vs. 57.8%, <i>p</i> = .02) and LA dilatation with >40 mL/m<sup>2</sup> (35.9% vs. 23.3%, <i>p</i> = .02) volumes were more frequent within these patients. AF recurrence was more frequent in patients who had previous ECV (HR = 1.32; 95% CI: 1.12–2.35; <i>p</i> = .01) and more than 1 shock to recover sinus rhythm (HR = 1.62; 95% CI: 1.07–1.63; <i>p</i> = .01). The SLAC, ALARMEc, ATLAS, and CAAP-AF scores were statistically significant, although with a moderate predictive capacity for post-ECV recurrence.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Risk scores analyzed showed a modest value predicting AF recurrence after ECV. Previous ECV, and greater difficulty in restoring SR were independent predictors of recurrence.</p>\n </section>\n </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"29 1","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13095","citationCount":"0","resultStr":"{\"title\":\"Usefulness of risk scores and predictors of atrial fibrillation recurrence after elective electrical cardioversion\",\"authors\":\"Daniel Águila-Gordo MD, Javier Jiménez-Díaz MD, PhD, Martín Negreira-Caamaño MD, Jorge Martínez-Del Rio MD, Cristina Ruiz-Pastor MD, Ignacio Sánchez Pérez MD, Jesús Piqueras-Flores MD, PhD\",\"doi\":\"10.1111/anec.13095\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Electrical cardioversion (ECV) is a frequently used procedure for restoring sinus rhythm in atrial fibrillation (AF); however, the rate of recurrence is high. The identification of patients at high risk of recurrence could influence the decision-making process. The present study evaluates the predictive value of risk scores in atrial fibrillation recurrence after elective electrical cardioversion.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Unicentric, observational, and prospective study of adult patients who have undergone an elective ECV as rhythm control strategy between July 2017 and September 2022.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>From the 283 analyzed patients (mean age 63.95 ± 10.76212, 74.9% male); 99 had paroxysmal AF (35%) and 159 (59%) presented AF recurrence during a follow-up of 6 months. In patients with post-ECV AF recurrence, the period of time from diagnosis until the performance of the procedure was longer (393 ± 891 vs. 195 ± 527, <i>p</i> = .02). No paroxysmal AF (71.3% vs. 57.8%, <i>p</i> = .02) and LA dilatation with >40 mL/m<sup>2</sup> (35.9% vs. 23.3%, <i>p</i> = .02) volumes were more frequent within these patients. AF recurrence was more frequent in patients who had previous ECV (HR = 1.32; 95% CI: 1.12–2.35; <i>p</i> = .01) and more than 1 shock to recover sinus rhythm (HR = 1.62; 95% CI: 1.07–1.63; <i>p</i> = .01). The SLAC, ALARMEc, ATLAS, and CAAP-AF scores were statistically significant, although with a moderate predictive capacity for post-ECV recurrence.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Risk scores analyzed showed a modest value predicting AF recurrence after ECV. Previous ECV, and greater difficulty in restoring SR were independent predictors of recurrence.</p>\\n </section>\\n </div>\",\"PeriodicalId\":8074,\"journal\":{\"name\":\"Annals of Noninvasive Electrocardiology\",\"volume\":\"29 1\",\"pages\":\"\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2023-11-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13095\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Noninvasive Electrocardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/anec.13095\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Noninvasive Electrocardiology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/anec.13095","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
导读:电复律(ECV)是恢复心房颤动(AF)患者窦性心律的常用方法;然而,复发率高。对复发高危患者的识别可以影响决策过程。本研究评估选择性电复律后房颤复发风险评分的预测价值。方法:对2017年7月至2022年9月期间接受选择性ECV作为节律控制策略的成年患者进行单中心、观察性和前瞻性研究。结果:283例患者(平均年龄63.95±10.76212岁,男性74.9%);随访6个月,发作性房颤99例(35%),复发159例(59%)。在ecv后房颤复发患者中,从诊断到实施手术的时间更长(393±891比195±527,p = 0.02)。无阵发性房颤(71.3% vs. 57.8%, p = 0.02)和LA扩张(>40 mL/m2, 35.9% vs. 23.3%, p = 0.02)在这些患者中更为常见。既往有ECV的患者房颤复发更频繁(HR = 1.32;95% ci: 1.12-2.35;p = 0.01)和1次以上休克恢复窦性心律(HR = 1.62;95% ci: 1.07-1.63;p = 0.01)。SLAC、ALARMEc、ATLAS和CAAP-AF评分具有统计学意义,尽管对ecv后复发具有中等预测能力。结论:风险评分分析显示,预测ECV后房颤复发的价值适中。既往的ECV和恢复SR的难度较大是复发的独立预测因素。
Usefulness of risk scores and predictors of atrial fibrillation recurrence after elective electrical cardioversion
Introduction
Electrical cardioversion (ECV) is a frequently used procedure for restoring sinus rhythm in atrial fibrillation (AF); however, the rate of recurrence is high. The identification of patients at high risk of recurrence could influence the decision-making process. The present study evaluates the predictive value of risk scores in atrial fibrillation recurrence after elective electrical cardioversion.
Methods
Unicentric, observational, and prospective study of adult patients who have undergone an elective ECV as rhythm control strategy between July 2017 and September 2022.
Results
From the 283 analyzed patients (mean age 63.95 ± 10.76212, 74.9% male); 99 had paroxysmal AF (35%) and 159 (59%) presented AF recurrence during a follow-up of 6 months. In patients with post-ECV AF recurrence, the period of time from diagnosis until the performance of the procedure was longer (393 ± 891 vs. 195 ± 527, p = .02). No paroxysmal AF (71.3% vs. 57.8%, p = .02) and LA dilatation with >40 mL/m2 (35.9% vs. 23.3%, p = .02) volumes were more frequent within these patients. AF recurrence was more frequent in patients who had previous ECV (HR = 1.32; 95% CI: 1.12–2.35; p = .01) and more than 1 shock to recover sinus rhythm (HR = 1.62; 95% CI: 1.07–1.63; p = .01). The SLAC, ALARMEc, ATLAS, and CAAP-AF scores were statistically significant, although with a moderate predictive capacity for post-ECV recurrence.
Conclusions
Risk scores analyzed showed a modest value predicting AF recurrence after ECV. Previous ECV, and greater difficulty in restoring SR were independent predictors of recurrence.
期刊介绍:
The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients.
ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation.
ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.