Predictors of sinus rhythm after electrical cardioversion of atrial fibrillation: results from a data mining project on the Flec-SL trial data set.

Abstract

AIMS:

Data mining is the computational process to obtain information from a data set and transform it for further use. Herein, through data mining with supportive statistical analyses, we identified and consolidated variables of the Flecainide Short-Long (Flec-SL-AFNET 3) trial dataset that are associated with the primary outcome of the trial, recurrence of persistent atrial fibrillation (AF) or death.

METHODS AND RESULTS:

The 'Ranking Instances by Maximizing the Area under the ROC Curve' (RIMARC) algorithm was applied to build a classifier that can predict the primary outcome by using variables in the Flec-SL dataset. The primary outcome was time to persistent AF or death. The RIMARC algorithm calculated the predictive weights of each variable in the Flec-SL dataset for the primary outcome. Among the initial 21 parameters, 6 variables were identified by the RIMARC algorithm. In univariate Cox regression analysis of these variables, increased heart rate during AF and successful pharmacological conversion (PC) to sinus rhythm (SR) were found to be significant predictors. Multivariate Cox regression analysis revealed successful PC as the single relevant predictor of SR maintenance. The primary outcome risk was 3.14 times (95% CI:1.7-5.81) lower in those who had successful PC to SR than those who needed electrical cardioversion.

CONCLUSIONS:

Pharmacological conversion of persistent AF with flecainide without the need for electrical cardioversion is a powerful and independent predictor of maintenance of SR. A strategy of flecainide pretreatment for 48 h prior to planned electrical cardioversion may be a useful planning of a strategy of long-term rhythm control.

• Authors: Emre Oto, Sercan Okutucu, Deniz Katircioglu-Öztürk, Halil Altay Güvenir, Ergun Karaagaoglu, Martin Borggrefe, Günter Breithardt, Andreas Goette, Ursula Ravens, Gerhard Steinbeck, Karl Wegscheider, Ali Oto, Paulus Kirchhof
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 19 Issue 6 Pg. 921-928 (Jun 01 2017) ISSN: 1532-2092 [Electronic] England
• PMID: 27377074 (Publication Type: Journal Article)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: [email protected].

Chemical References

• Anti-Arrhythmia Agents
• Flecainide

Topics

• Action Potentials (drug effects)
• Algorithms
• Anti-Arrhythmia Agents (adverse effects, therapeutic use)
• Area Under Curve
• Atrial Fibrillation (diagnosis, mortality, physiopathology, therapy)
• Data Mining (methods)
• Databases, Factual
• Datasets as Topic
• Electric Countershock (adverse effects, mortality)
• Female
• Flecainide (adverse effects, therapeutic use)
• Heart Conduction System (drug effects, physiopathology)
• Heart Rate (drug effects)
• Humans
• Kaplan-Meier Estimate
• Linear Models
• Machine Learning
• Male
• Multivariate Analysis
• Nonlinear Dynamics
• Proportional Hazards Models
• ROC Curve
• Randomized Controlled Trials as Topic
• Recurrence
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome