CHA 2 DS 2 VASc score predicts unsuccessful electrical cardioversion in patients with persistent atrial fibrillation

• Published in: Internal medicine journal 2017-03, Vol.47 (3), p.275-279
• Main Authors: Mlodawska, Elzbieta, Tomaszuk-Kazberuk, Anna, Lopatowska, Paulina, Kaminski, Marcin, Musial, Wlodzimierz J
• Format: Article
• Language: English
• Subjects: Aged; Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - complications; Atrial Fibrillation - mortality; Electric Countershock - mortality; Female; Health Status Indicators; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Quality of Life; Reproducibility of Results; Risk Assessment; Risk Factors; Stroke - mortality; Stroke - prevention & control; Thromboembolism - complications; Thromboembolism - mortality
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.13319

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 DS 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 DS VASc score was not used until now in predicting the effectiveness of electrical cardioversion. To assess the value of CHA DS VASc score in predicting unsuccessful electrical cardioversion. 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. Out of 3500 hospitalised patients with AF, 258 (mean age 64 ± 11 years, 64% men) underwent electrical cardioversion. The CHA DS 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 DS VASc score (P = 0.002). The CHA DS VASc 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 DS VASc 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 DS VASc score ≥ 2 than in patients with a CHA DS VASc score of 0 or 1 (OR 3.06; CI: 1.03-9.09; P = 0.044). The CHA DS 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.