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Anticoagulation, CHA2DS2VASc Score, and Thromboembolic Risk of Cardioversion of Acute Atrial Fibrillation (from the FinCV Study).

Published on Apr 1, 2016in American Journal of Cardiology2.843
· DOI :10.1016/j.amjcard.2016.01.024
Toni Grönberg1
Estimated H-index: 1
(UTU: University of Turku),
Juha Hartikainen37
Estimated H-index: 37
+ 3 AuthorsK.E. Juhani Airaksinen30
Estimated H-index: 30
(TYKS: Turku University Hospital)
Abstract
The efficacy of the anticoagulation in preventing thromboembolic complications (TEC) and the usefulness of the CHA 2 DS 2 VASc score for assessing stroke risk during cardioversion of acute atrial fibrillation (AF) are unclear. Thus, our objectives were to assess the ability of the CHA 2 DS 2 VASc score to predict TEC and to evaluate the efficacy of anticoagulation in the prevention of TEC in Finnish CardioVersion (FinCV) study. The FinCV is a retrospective, multicenter study of 3,143 patients, who underwent 7,660 cardioversions for acute AF. The value of the CHA 2 DS 2 VASc score in predicting TEC was analyzed separately in cardioversions performed without and with anticoagulation. A total of 40 definite TEC (0.6%) occurred after 7,237 successful cardioversions and 1 stroke (0.2%) after 423 unsuccessful procedures. In 5,362 cardioversions performed without anticoagulation, the risk of definite TEC increased significantly from 0.4% in patients with a CHA 2 DS 2 VASc score of 0 to 1 to 2.3% in those with score of ≥5 (p 2 DS 2 VASc score was 0.72 (0.61 to 0.83) in predicting definite TEC in non-anticoagulated patients with first cardioversion. The incidence of definite TEC was significantly lower in 2,298 cardioversions performed during anticoagulation (0.1% vs 0.7%, p = 0.001), and the preventive effect of anticoagulation was significant in patients with a score of ≥2 (0.2% vs 1.1%, p = 0.001). In conclusion, CHA 2 DS 2 VASc score is a strong predictor of TEC in cardioversion of acute AF performed without anticoagulation. Importantly, periprocedural anticoagulation reduced the risk of TEC by 82%. The overall risk of these complications was low after failed cardioversion.
  • References (27)
  • Citations (15)
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References27
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#1B M Toni Grönberg (TYKS: Turku University Hospital)H-Index: 1
#2Juha HartikainenH-Index: 37
Last. K.E. Juhani Airaksinen (TYKS: Turku University Hospital)H-Index: 30
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Background Data on predictors of failure of electrical cardioversion of acute atrial fibrillation are scarce. Methods We explored 6,906 electrical cardioversions of acute (<48 hours) atrial fibrillation in 2,868 patients in a retrospective multicenter study. Results The success rate of electrical cardioversion was 94.2%. In 26% of unsuccessful cardioversions, the cardioversion was performed successfully later. Antiarrhythmic drug therapy, short (<12 hours) duration of atrial fibrillation episode...
11 CitationsSource
#1Craig T. January (Elsevier)H-Index: 42
#2L. Samuel WannH-Index: 25
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Jeffrey L. Anderson, MD, FACC, FAHA, Chair Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect Nancy M. Albert, PhD, RN, FAHA Biykem Bozkurt, MD, PhD, FACC, FAHA Ralph G. Brindis, MD, MPH, MACC Mark A. Creager, MD, FACC, FAHA[#][1] Lesley H. Curtis, PhD, FAHA David DeMets, PhD[#][1] Robert A
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#1Maura Marcucci (McMaster University)H-Index: 24
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Abstract Background The choice to recommend antithrombotic therapy to patients with atrial fibrillation should rely on cardioembolic and bleeding risk stratification. Sharing some risk factors, schemes to predict thrombotic and bleeding risk are expected not to be independent, yet the degree of their association has never been clearly quantified. Methods We described the cardioembolic (Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic atta...
21 CitationsSource
#1Ilpo Nuotio (TYKS: Turku University Hospital)H-Index: 21
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Aims To determine the incidence and risk factors of arrhythmic complications after electrical cardioversion of acute atrial fibrillation (AF). Methods and results Our retrospective multicentre study collected data from 7660 cardioversions of acute ( 5 s) occurred immediately after 51 cardioversions leading to a short resuscitation in seven cases and two patients needed extrinsic pacing after the cardioversion. In nine cases, asystole was followed by bradycardia. Bradycardic ventricular rate (<40...
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Abstract Background Current recommendations for anticoagulation management during cardioversion are largely based on historical data and expert consensus. Methods and results To characterize current practice of anticoagulation during and after elective cardioversion for AF and the risk of stroke and bleeding events, all patients enrolled into the Flec-SL trial were analyzed for stroke/transient ischemic attack and major bleeds after cardioversion. Flec-SL (ISRCTN62728743, NCT00215774) enrolled 6...
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