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CHA 2 DS 2 VASc score predicts unsuccessful electrical cardioversion in patients with persistent atrial fibrillation
Author(s) -
Mlodawska Elzbieta,
TomaszukKazberuk Anna,
Lopatowska Paulina,
Kaminski Marcin,
Musial Wlodzimierz J.
Publication year - 2017
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13319
Subject(s) - medicine , atrial fibrillation , cardioversion , stroke (engine) , cardiology , population , electrical cardioversion , mechanical engineering , environmental health , engineering
Background Atrial fibrillation ( AF ) is the most common arrhythmia occurring in 2% of the population. It is known that AF increases morbidity and limits quality of life. The CHA 2 DS 2 VASc score (congestive heart failure/left ventricular dysfunction, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65–74 and sex category (female)) is widely used to assess thrombotic complications. The CHA 2 DS 2 VASc score was not used until now in predicting the effectiveness of electrical cardioversion. Aim To assess the value of CHA 2 DS 2 VASc score in predicting unsuccessful electrical cardioversion. Methods We analysed 258 consecutive patients with persistent AF who underwent electrical cardioversion between January 2012 and April 2016 in a Cardiology University Centre in Poland. Results Out of 3500 hospitalised patients with AF , 258 (mean age 64 ± 11 years, 64% men) underwent electrical cardioversion. The CHA 2 DS 2 VASc score in analysed population (258 patients) was 2.5 ± 1.7 (range 0–8), and the HAS‐BLED (hypertension, abnormal liver or renal function, stroke, bleeding, labile international normalised ratio, elderly, drugs or alcohol) was 1 ± 0.9 (range 0–4). Electrical cardioversion was unsuccessful in 12%. Factors associated with unsuccessful cardioversion were age ( P = 0.0005), history of ischaemic stroke ( P = 0.04), male gender ( P = 0.01) and CHA 2 DS 2 VAS c score ( P = 0.002). The CHA 2 DS 2 VAS c score in patients who had unsuccessful cardioversion was higher compared to patients who had successful cardioversion – 3.5 versus 2.4 ( P = 0.001). In the logistic regression model, if the CHA 2 DS 2 VAS c score increases by 1, the odds of unsuccessful cardioversion increase by 39% (odds ratio ( OR ) 1.39; confidence interval ( CI ): 1.12–1.71; P = 0.002). The odds of unsuccessful cardioversion are three times higher in patients with a CHA 2 DS 2 VAS c score ≥ 2 than in patients with a CHA 2 DS 2 VASc score of 0 or 1 ( OR 3.06; CI : 1.03–9.09; P = 0.044). Conclusion The CHA 2 DS 2 VASc score routinely used in thromboembolic risk assessment may be a simple, easy and reliable scoring system that can be used to predict unsuccessful electrical cardioversion.