Falsetti Lorenzo, Viticchi Giovanna, Tarquinio Nicola, Silvestrini Mauro, Capeci William, Balloni Andrea, Catozzo Vania, Gentile Adelina, Pellegrini Francesco
aInternal and Sub-Intensive Medicine Department, A.O.U. 'Ospedali Riuniti', Ancona, Italy bDepartment of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy cDepartment of Internal Medicine, Ospedale 'S.S. Benvenuti e Rocco', Osimo (Ancona), Italy.
J Cardiovasc Med (Hagerstown). 2014 Aug;15(8):636-41. doi: 10.2459/JCM.0000000000000139.
In hemodynamically stable patients, mortality and morbidity related to atrial fibrillation are mainly due to cardioembolic disorder. No difference in the survival rate and incidence of embolic events has been described in patients undergoing rhythm or rate control if the latter is combined with an appropriate anticoagulant therapy. CHA2DS2-VASc is a score that allows clinicians to stratify embolic risk in patients affected by nonvalvular atrial fibrillation. Each item can be involved in triggering and maintaining atrial fibrillation. Thus, we hypothesized that CHA2DS2-VASc may help to predict early recurrences after cardioversion.
A total of 319 consecutive patients, admitted to our emergency department or hemodynamically stable persistent atrial fibrillation, were enrolled and treated with electrical or pharmacological sinus rhythm restoration. Outcome was defined as recurrence of atrial fibrillation 5 days after cardioversion. Predicted probability of sinus rhythm stability was assessed with an ordinal regression model using CHA2DS2-VASc as an independent variable.
The model showed a progressive decrease in the predicted probability of sinus rhythm stability after electrical or pharmacological cardioversion along with an increase in the CHA2DS2-VASc score. A logarithmic relationship was the best-fit trend among CHA2DS2-VASc ranks and the predicted probability of sinus rhythm stability in patients undergoing both electrical and pharmacological cardioversion (r(2) = 0.98, P < 0.05 for electrical cardioversion; r(2) = 0.91, P < 0.05 for pharmacological cardioversion).
Our preliminary results suggest that CHA2DS2-VASc score could be useful in evaluating the risk of early recurrence of atrial fibrillation after cardioversion. This information may have implications for disease monitoring and treatment strategies in clinical practice.
在血流动力学稳定的患者中，与心房颤动相关的死亡率和发病率主要归因于心源性栓塞疾病。如果节律控制或心率控制联合适当的抗凝治疗，在接受这两种治疗的患者中，生存率和栓塞事件发生率并无差异。CHA2DS2-VASc评分可帮助临床医生对非瓣膜性心房颤动患者的栓塞风险进行分层。每个因素都可能参与心房颤动的触发和维持。因此，我们推测CHA2DS2-VASc评分可能有助于预测复律后早期复发情况。
连续纳入319例因血流动力学稳定的持续性心房颤动而入住我院急诊科的患者，接受电复律或药物复律治疗。观察终点定义为复律后5天心房颤动复发。以CHA2DS2-VASc评分为自变量，采用有序回归模型评估窦性心律稳定的预测概率。
该模型显示，电复律或药物复律后，窦性心律稳定的预测概率随CHA2DS2-VASc评分升高而逐渐降低。在接受电复律和药物复律的患者中，CHA2DS2-VASc分级与窦性心律稳定的预测概率之间呈对数关系为最佳拟合趋势（电复律：r(2)=0.98，P<0.05；药物复律：r(2)=0.91，P<0.05）。
我们的初步结果表明，CHA2DS2-VASc评分可能有助于评估复律后心房颤动早期复发风险。该信息可能对临床实践中的疾病监测和治疗策略具有指导意义。
