Mlodawska Elzbieta, Tomaszuk-Kazberuk Anna, Lopatowska Paulina, Kaminski Marcin, Musial Wlodzimierz J
Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
Intern Med J. 2017 Mar;47(3):275-279. 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.
心房颤动（AF）是最常见的心律失常，在2%的人群中发生。已知AF会增加发病率并限制生活质量。CHA₂DS₂-VASc评分（充血性心力衰竭/左心室功能障碍、高血压、年龄≥75岁（加倍）、糖尿病、中风（加倍）、血管疾病、年龄65 - 74岁和性别类别（女性））被广泛用于评估血栓形成并发症。到目前为止，CHA₂DS₂-VASc评分尚未用于预测电复律的有效性。
评估CHA₂DS₂-VASc评分在预测电复律失败中的价值。
我们分析了2012年1月至2016年4月在波兰一所大学心脏病中心接受电复律的258例持续性AF连续患者。
在3500例住院的AF患者中，258例（平均年龄64±11岁，64%为男性）接受了电复律。分析人群（258例患者）的CHA₂DS₂-VASc评分为2.5±1.7（范围0 - 8），HAS-BLED（高血压、肝或肾功能异常、中风、出血、国际标准化比值不稳定、老年人、药物或酒精）为1±0.9（范围0 - 4）。电复律失败率为12%。与电复律失败相关的因素有年龄（P = 0.0005）、缺血性中风病史（P = 0.04）、男性性别（P = 0.01）和CHA₂DS₂-VASc评分（P = 0.002）。电复律失败患者的CHA₂DS₂-VASc评分高于成功患者 - 3.5对2.4（P = 0.001）。在逻辑回归模型中，如果CHA₂DS₂-VASc评分增加1，电复律失败的几率增加39%（比值比（OR）1.39；置信区间（CI）：1.12 - 1.71；P = 0.002）。CHA₂DS₂-VASc评分≥2的患者电复律失败的几率是CHA₂DS₂-VASc评分为0或1的患者的三倍（OR 3.06；CI：1.03 - 9.09；P = 0.044）。
常用于血栓栓塞风险评估的CHA₂DS₂-VASc评分可能是一种简单、易行且可靠的评分系统，可用于预测电复律失败。
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