CHA2DS2-VASc and the risk of early AF relapse: another reason for rate control and anticoagulation

Background: Atrial fibrillation (AF) is the most frequent cardiac arrhythmia observed in Internal Medicine departments. CHA2DS2- VASc1 is a clinical score which summarizes the coexistence of cardiopathy, hypertension, ageing, diabetes, previous stroke, cardiovascular pathologies and sex, used in predicting the cardioembolic risk, thus representing a tool to guide the anticoagulant therapy. Aims: To evaluate if this ruler could predict early relapses of AF after an electric or pharmacologic procedure of sinus rhythm (SR) restoration. Patients and Methods: We retrospectively evaluated 220 consecutive patients admitted to our Internal Medicine Department for AF undergoing to electric or pharmacologic SR restoration. For each patient we evaluated the full history and the drugs used. Cardiovascular risk factors, presence of cardiac valve pathologies, neoplasms, current use of statins, ACE-inhibitors, angiotensin receptor blockers, loop diuretics, amiodarone and warfarin were also investigated and S330 Intern Emerg Med (2011) 6 (Suppl 2):S191–S392 123 synthesized as binary variables. CHA2DS2-VASc was calculated and used as an ordinal variable. Absence of early relapse of AF, defined as maintenance of sinus rhythm 48 h after SR restoration was defined as a binary variable. We evaluated the correlation between absence of early relapses of AF and CHA2DS2-VASc with an ordinal regression model, including hypothyroidism, cardiac valve pathologies, neoplasms and each single drug as covariates. Model fitting test resulted significant (p\0.0001), while Pearson and Deviance test resulted non-significant, indicating a significantly predictive model. Analysis was conducted with SPSS 13.0 for Windows systems. Results: 18 patients with spontaneous recover of SR were excluded from analysis. A final sample of 202 patients was considered. A higher predicted probability of absence of early relapses of AF was related to lower CHA2DS2-VASc values: patients without early relapses of AF had a five-fold increase (OR = 5.1; 95%CI: 3.82-6.79; p\0.05) of having a normal CHA2DS2-VASc score. The probability of sinus rhythm maintenance lessened significantly along with the increase of CHA2DS2-VASc score: higher classes were strongly related to a high probability of early relapses. Discussion: Non-valvular AF is a complex disease, related to electrical and mechanical remodeling of atrial myocardium. CHA2DS2- VASc score, already used to assess the risk of thromboembolic events, summarizes many of the factors involved in mechanical remodeling. This index can predict the likelihood of early relapses of AF after electrical or pharmacological attempts of restoration of SR. Since restoration of SR is not a risk-free procedure, CHA2DS2-VASc could help the physician to decide both for the antithrombotic