UTILITY OF THE CHADS2 AND CHA2DS2-VASc SCORES TO PREDICT EMBOLIC RISK AFTER DIRECT-CURRENT CARDIOVERSION IN NON-VALVULAR ATRIAL FIBRILLATION
A. García-Fernández, F. Marín-Ortuño, V. Roldán-Schilling, J.G. Martínez-Martínez, A, Ibáñez-Criado, J.L. Ibáñez-Criado, , M. Valdés,, F. Sogorb-Garri
Arrhtyhmia Unit, Cardiology Department, general Hospital of Alicante, Spain. Cardiology Department, Hospital Virgen de la Arrixaca, Murcia, Spain. Haematology Department, Hospital Morales Meseguer, Murcia, Spain
Introduction: The usefulness of the CHADS2 and CHA2DS2-VASc scores to predict thromboembolism in non-valvular AF has been well validated, but their predictive value after electrical cardioversion has not been thoroughly investigated. The aim of this study is to analyze the role of both scores to predict thromboembolic risk in a real-world cohort of patients with AF who undergo DC cardioversion.
Methods: We included 326 consecutive patients who underwent 456 programmed cardioversions between January 2008 and August 2011. We calculated the association between both scales and the development of all embolic events during follow-up.
Results: During a median follow-up of 740 (327-1224) days, there were 20 embolic events (4.38%), (2 fatal), with an annual rate of embolism of 2.16%. We found a significant association between both risk scales and the incidence of embolic events (CHADS2: HR=1.77; 95%CI: 1.25-2.51; p=0.001); (CHA2DS2-VASc: HR=1.68; 95%CI: 1.29-2.19; p<0.001).
Conclusions: CHADS2 and CHA2DS2-VASc risk scores are good predictors of embolic risk in real-world AF patients undergoing DC cardioversion.
Patient Characteristics
| Variables
|
Number
|
| Patients (n) |
11 |
| Pulmonary veins (n) |
41 |
| Gender (men/women) |
8/3 |
| Age (years) |
58.9 ± 8.7 (46-71) |
| BMI |
29 ± 3.5 |
| Additional CTI ablation (n, %) |
1(9.0%) |
| Average procedure time (minutes) |
180±44 |
| Medical History |
|
| Hypertension (n, %) |
4(36.3%) |
| CHF (n, %) |
0(0%) |
| Atrial flutter (n, %) |
1(9.0%) |
| CAD (n, %) |
2(18.1%) |
| Medication Use |
|
| Amiodarone |
1(9.0%) |
| Flecainide |
6(55.5%) |
| Sotalol |
2(18.1%) |
| Disease Characteristics |
|
| Paroxysmal/persistent AF (n/n, %/%) |
10/1(90% / 10%) |
| AF duration (years, mean±SD) |
5±4.2 |
| LVEF (%, mean±SD) |
58±4 |
| LA volume (cc, mean±SD) |
60±9 |
| Number of prior electrical cardioversions (n, %) |
1(9%) |
| Number of prior AF ablation patients (n, %) |
0(0%) |
| Number of prior pharmacological cardioversions (n, %) |
1(9%) |
| Number of prior AFl ablation patient numbers (n, %) |
0(0%) |
Annual rate of embolic events depending on CHADS2 AND CHA2DS2-VASc scores.
| CHADS2 score
|
Annual embolic rate (%)
|
No
|
Yes
|
Total
|
| 0 |
0.89 |
54 |
1 |
55 |
| 1 |
0.83 |
171 |
3 |
174 |
| 2 |
2.36 |
119 |
6 |
125 |
| 3 |
3.55 |
64 |
5 |
69 |
| 4 |
8.10 |
25 |
5 |
30 |
| 5 |
0 |
2 |
0 |
2 |
| 6 |
0 |
1 |
0 |
1 |
| CHA2DS2-VASc Score |
|
|
|
|
| 0 |
0 |
25 |
0 |
25 |
| 1 |
0.63 |
76 |
6 |
77 |
| 2 |
1.15 |
124 |
3 |
127 |
| 3 |
1.61 |
88 |
3 |
91 |
| 4 |
2.61 |
71 |
4 |
75 |
| 5 |
6.53 |
26 |
4 |
30 |
| 6 |
7.25 |
23 |
4 |
27 |
| 7 |
24.5 |
1 |
1 |
2 |
| 8 |
0 |
1 |
0 |
1 |
