Nuovo score predittivo di cardioversione spontanea a ritmo sinusale nei pazienti con fibrillazione striale sintomatica

Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well-known. Objective: To develop and validate a score to determine the probability of SCV to SR in patients presenting to the ED with hemodynamically stable, symptomatic AF. Methods: This retrospective, observational study enrolled consecutive patients admitted with AF to the ED. Variables associated to SCV during 6-hours wait-and-watch approach were used to develop and validate a score to determine the probability of SCV to SR in AF patients. The study was divided in two phases: 1) score development; 2) validation of the predictive score. Results: Out of 749 eligible patients, 446 patients were included in the derivation cohort, whereas 302 patients were included in the validation cohort. In the derivation cohort, based on multivariable logistic analysis, a probability score weight was developed including: previous SCV (3 points), AF-related symptoms duration < 24 h (5 points), age  65 years (3 points), female sex (2 points) and chronic oral anticoagulation (-4 points). The score allowed to divide patients in three groups based on probability of SCV to SR during the 6-hours observation period. The probability prediction model showed an area under the curve (AUC) of 0.750 and 0.725 in the derivation and validation cohorts, respectively. Conclusions: The proposed score allows to predict SCV probability with good accuracy and may help physicians in tailoring AF management in an effective and timely manner.