title: CHA2DS2VASc score predicts unsuccessful electrical cardioversion in patients with persistent atrial fibrillation.
abstract: 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 CHA2DS2VASc 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 CHA2DS2VASc score was not used until now in predicting the effectiveness of electrical cardioversion.
  
  
  OBJECTIVE
  To assess the value of CHA2DS2VASc 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 ± 11 years, 64% men) underwent electrical cardioversion. The CHA2DS2VASc 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 CHA2DS2VASc score (P = 0.002). The CHA2DS2VASc 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 CHA2DS2VASc 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 CHA2DS2VASc score ≥ 2 than in patients with a CHA2DS2VASc score of 0 or 1 (OR 3.06; CI: 1.03-9.09; P = 0.044).
  
  
  CONCLUSIONS
  The CHA2DS2VASc 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.
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Mlodawska
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Tomaszuk-Kazberuk
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Paulina
authors.initials: P
authors.lastname: Lopatowska
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kaminski
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Wlodzimierz J
authors.initials: WJ
authors.lastname: Musial
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D004554:Electric Countershock / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*; D013923:Thromboembolism / Q000150:complications* / Q000401:mortality
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: 
  CHA2DS2VASc score; atrial fibrillation; cardioversion