SPC365

A simplified predictive score for atrial fibrillation recurrence after electrical cardioversion using electrocardiographic parameters: the RECAF-Score

Session: SESSÃO DE POSTERS 53 - FIBRILHAÇÃO AURICULAR E ARRITMIAS AURICULARES COMPLEXAS
Speaker: João Gouveia Fiuza

Congress: CPC 2025
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: João Gouveia Fiuza; Mariana Duarte Almeida; Gonçalo RM Ferreira; Francisco Rodrigues Santos; Oliver Kungel; Vanda Devesa Neto; Inês Pires; Nuno Craveiro; Júlio Gil Pereira; António Costa

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> Atrial fibrillation (AF) is the most common supraventricular arrhythmia and is linked to significant morbidity. Despite its role as a rhythm control strategy, electrical cardioversion (ECV) is associated with high recurrence rates. Identifying patients at high risk of AF recurrence is crucial for targeted follow-up and improved outcomes. Electrocardiographic (ECG) parameters are simple, reproducible and offer potential for risk prediction. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> To develop a simplified predictive score for identifying patients at high risk of AF recurrence within 12 months (12M).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">A single-center retrospective study was performed including 49 patients admitted for ECV in AF. Key ECG parameters (heart rate, PR interval, maximum and minimum P wave duration, P wave dispersion, and P wave morphology) were analyzed after successful ECV. Chi-square and Mann-Whitney U were used for comparison between groups. The RECAF-Score (Recurrence after Electrical Cardioversion in AF Score) formula was derived by assigning weights to the predictors based on their relative contributions in the multivariate analysis, scaling them to balance their ranges: 1 point for PR maximum duration greater than 175ms, 2 points for P wave maximum duration greater than 120ms and 1 point for P wave dispersion greater than 40ms. Internal validation was conducted using receiver operating characteristic (ROC) curve analysis to assess the score&rsquo;s predictive value. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> Mean age was 62&plusmn;8 years; 67,3% were men. At 12M, 30 patients (61,2%) had AF recurrence. At 12M, P wave maximum duration greater than 120ms (p&lt;0.01), PR interval greater than 175ms (p&lt;0.01) and P wave dispersion greater than 40ms (p&lt;0.01) were associated with AF recurrence. A predictive score for AF recurrence at 12 months was developed using logistic regression analysis. Despite the individual predictors being non-significant in logistic regression, their combined effect demonstrated acceptable model performance. ROC analysis was performed and revealed that RECAF-Score, achieved an area under the curve of 0.815 (p &lt; 0.001). The cut-off was 2.5, achieving a sensitivity of 93.3% and specificity of 57.9%. Using this threshold, patients were classified as high or low risk for AF recurrence. Crosstabulation of the dichotomized score demonstrated a significant association with AF recurrence (93.3% vs 6.7%, </span></span></span><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">&chi;</span></span></span><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">2=15.662, p&lt;0.001).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">The RECAF-Score demonstrated good discrimination for AF recurrence at 12M. The performance highlights the score&#39;s ability to discriminate between patients at high and low risk of AF recurrence. These findings suggest the score&rsquo;s potential utility, although further validation in larger, independent cohorts is warranted, given the above-mentioned caveats.</span></span></span></span></span></p>