A New Prognostic Score for Predicting Atrial Fibrillation Recurrence After Electrical Cardioversion: SLASH Score.

Area of Science:

• Cardiology
• Clinical Prediction Models

Background:

• Predicting atrial fibrillation (AF) recurrence post-electrical cardioversion (ECV) remains challenging.
• The existing SLAC score requires external validation for improved accuracy.
• External validation of the SLAC score and development of a superior predictive model are crucial.

Purpose of the Study:

• To externally validate the SLAC score for predicting 6-month AF recurrence after ECV.
• To develop an improved predictive model for AF recurrence post-ECV.

Main Methods:

• Retrospective study of 361 patients undergoing successful ECV for AF (2015-2020).
• Exclusion of patients with atrial flutter, complex congenital heart disease, or early AF ablation.
• Development of the SLASH score using multivariable logistic regression and assessment of discrimination (AUC) and calibration.

Main Results:

• 53.7% of patients experienced AF recurrence within 6 months.
• The SLAC score showed moderate discrimination (AUC 0.70), improved to 0.72 with a cutoff ≥ 6.
• The novel SLASH score demonstrated superior discrimination (AUC 0.78) with distinct risk groups (16.1% to 78.5% recurrence).

Conclusions:

• The SLAC score offers moderate prediction of 6-month AF recurrence post-ECV.
• The SLASH score exhibits superior performance for risk stratification and rhythm management.
• Prospective validation of the SLASH score is recommended for clinical implementation.