CHA2DS2VASc score predicts unsuccessful electrical cardioversion in patients with persistent atrial fibrillation

Background Atrial fibrillation (AF) is the most common arrhythmia occurring in 2% of the population. It is known thatAFincreases morbidity and limits quality of life. TheCHA2DS2VAScscore (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. TheCHA2DS2VAScscore was not used until now in predicting the effectiveness of electrical cardioversion. Aim To assess the value ofCHA2DS2VAScscore in predicting unsuccessful electrical cardioversion. Methods We analysed 258 consecutive patients with persistentAFwho underwent electrical cardioversion between January 2012 and April 2016 in a Cardiology University Centre in Poland. Results Out of 3500 hospitalised patients withAF, 258 (mean age 64 ± 11 years, 64% men) underwent electrical cardioversion. TheCHA2DS2VAScscore in analysed population (258 patients) was 2.5 ± 1.7 (range 0–8), and theHAS‐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) andCHA2DS2VASc score (P = 0.002). TheCHA2DS2VASc 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 theCHA2DS2VASc 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 aCHA2DS2VASc score ≥ 2 than in patients with aCHA2DS2VASc scoreof 0 or 1 (OR3.06;CI: 1.03–9.09;P = 0.044). Conclusion TheCHA2DS2VAScscore routinely used in thromboembolic risk assessment may be a simple, easy and reliable scoring system that can be used to predict unsuccessful electrical cardioversion.