CHA sub(2)DS sub(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
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.13319

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 sub(2)DS sub(2)VASc score (congestive heart failure/left ventricular dysfunction, hypertension, age greater than or equal to 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65-74 and sex category (female)) is widely used to assess thrombotic complications. The CHA sub(2)DS sub(2)VASc score was not used until now in predicting the effectiveness of electrical cardioversion. Aim To assess the value of CHA sub(2)DS sub(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 plus or minus 11years, 64% men) underwent electrical cardioversion. The CHA sub(2)DS sub(2)VASc score in analysed population (258 patients) was 2.5 plus or minus 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 plus or minus 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 sub(2)DS sub(2)VASc score ( P =0.002). The CHA sub(2)DS sub(2)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 sub(2)DS sub(2)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 sub(2)DS sub(2)VASc score greater than or equal to 2 than in patients with a CHA sub(2)DS sub(2)VASc score of 0 or 1 (OR 3.06; CI: 1.03-9.09; P =0.044). Conclusion The CHA sub(2)DS sub(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.