Background: Cardioembolic pathology is themain cause ofmortality and morbidity in hemodynamically stable patients affected with atrial fibrillation (AF). The risk of embolic events is significantly increased from recurrences after cardioversion (CV). No difference has been described in the survival rate and incidence of embolic events in patient undergoing rhythm or rate control combined with an appropriate anticoagulant therapy. CHA2DS2-VASc is a score that allows clinicians to stratify embolic risk in patients affected by non-valvular AF. Each itemcan be involved in triggering and maintaining AF. CHA2DS2-VASc score may help to predict early recurrences of AF after CV. Methods: 298 consecutive patients, admitted to our Emergency Department (ED) for hemodynamically stable persistent AF, were enrolled and treated with electrical or pharmacological sinus rhythm (SR) restoration. Patients with acute heart failure, acute pulmonary embolism, acute coronary syndrome (ACS), hyperthyroidism, valvular AF, and left atrium diameter above 50 mm, were excluded from further analyses for the higher risk of AF relapse after cardioversion. Oral anticoagulants and amiodarone were started three weeks before cardioversion. Patients with suboptimal control of oral anticoagulant levels and unsuccessful cardioversion procedure were also excluded. Outcome was defined as stability of SR within 24 h from procedure. Predicted probability of SR stability was assessed with an ordinal regression model using CHA2DS2-VASc as independent variable. Results: 213 patients were suitable for the final analysis. 140 patients underwent to electrical, 73 to pharmacologic cardioversion. The ordinal regression model resulted statistically significant (p b 0.05), showing a progressive decrease in the predicted probability of SR stability after electrical or pharmacological CV along with the increase in the CHA2DS2- VASc score. A logarithmic relationship was found to be the best-fit trend among CHA2DS2-VASc ranks and the predicted probability of SR stability both in patients undergoing electrical and pharmacological CV (r2=0.98, p b 0.05 for electric cardioversion; r2=0.91, p b 0.05 for pharmacological CV). CHA2DS2-VASc was related to an increased likelihood of SR stability for scores ranging between 0 and 2 for electric procedures while pharmacologic sinus rhythm restoration seemed to be more stable even in higher CHA2DS2-VASc ranks. Conclusions: Our preliminary results suggest that CHA2DS2-VASc score could be useful in evaluating the risk of early recurrence of AF after cardioversion. According to our findings, CHA2DS2-VASc could be suggested as a useful stratification tool for themanagement of hemodynamically stable elderly patient with AF. This information may have implications for disease monitoring and treatment strategies in clinical practice.
A different use of the CHA2DS2-VASc: Risk stratification of early recurrence of atrial fibrillation
Falsetti, L.
;
2013
Abstract
Background: Cardioembolic pathology is themain cause ofmortality and morbidity in hemodynamically stable patients affected with atrial fibrillation (AF). The risk of embolic events is significantly increased from recurrences after cardioversion (CV). No difference has been described in the survival rate and incidence of embolic events in patient undergoing rhythm or rate control combined with an appropriate anticoagulant therapy. CHA2DS2-VASc is a score that allows clinicians to stratify embolic risk in patients affected by non-valvular AF. Each itemcan be involved in triggering and maintaining AF. CHA2DS2-VASc score may help to predict early recurrences of AF after CV. Methods: 298 consecutive patients, admitted to our Emergency Department (ED) for hemodynamically stable persistent AF, were enrolled and treated with electrical or pharmacological sinus rhythm (SR) restoration. Patients with acute heart failure, acute pulmonary embolism, acute coronary syndrome (ACS), hyperthyroidism, valvular AF, and left atrium diameter above 50 mm, were excluded from further analyses for the higher risk of AF relapse after cardioversion. Oral anticoagulants and amiodarone were started three weeks before cardioversion. Patients with suboptimal control of oral anticoagulant levels and unsuccessful cardioversion procedure were also excluded. Outcome was defined as stability of SR within 24 h from procedure. Predicted probability of SR stability was assessed with an ordinal regression model using CHA2DS2-VASc as independent variable. Results: 213 patients were suitable for the final analysis. 140 patients underwent to electrical, 73 to pharmacologic cardioversion. The ordinal regression model resulted statistically significant (p b 0.05), showing a progressive decrease in the predicted probability of SR stability after electrical or pharmacological CV along with the increase in the CHA2DS2- VASc score. A logarithmic relationship was found to be the best-fit trend among CHA2DS2-VASc ranks and the predicted probability of SR stability both in patients undergoing electrical and pharmacological CV (r2=0.98, p b 0.05 for electric cardioversion; r2=0.91, p b 0.05 for pharmacological CV). CHA2DS2-VASc was related to an increased likelihood of SR stability for scores ranging between 0 and 2 for electric procedures while pharmacologic sinus rhythm restoration seemed to be more stable even in higher CHA2DS2-VASc ranks. Conclusions: Our preliminary results suggest that CHA2DS2-VASc score could be useful in evaluating the risk of early recurrence of AF after cardioversion. According to our findings, CHA2DS2-VASc could be suggested as a useful stratification tool for themanagement of hemodynamically stable elderly patient with AF. This information may have implications for disease monitoring and treatment strategies in clinical practice.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
