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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 Cardiology2.84
· DOI :10.1016/j.amjcard.2016.01.024
Toni Grönberg1
Estimated H-index: 1
(UTU: University of Turku),
Juha Hartikainen40
Estimated H-index: 40
+ 3 AuthorsK.E. Juhani Airaksinen44
Estimated H-index: 44
(TYKS: Turku University Hospital)
Cite
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 (12)
Cite
References27
Newest
Published on Mar 1, 2015in Pacing and Clinical Electrophysiology1.34
B M Toni Grönberg1
Estimated H-index: 1
(TYKS: Turku University Hospital),
Juha Hartikainen40
Estimated H-index: 40
+ 5 AuthorsK.E. Juhani Airaksinen44
Estimated H-index: 44
(TYKS: Turku University Hospital)
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...
Published on Dec 2, 2014in Circulation23.05
Craig T. January49
Estimated H-index: 49
(Elsevier),
L. Samuel Wann27
Estimated H-index: 27
+ 13 AuthorsMichael E. Field28
Estimated H-index: 28
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
Published on Oct 1, 2014in The American Journal of Medicine4.76
Maura Marcucci24
Estimated H-index: 24
(McMaster University),
Gregory Y.H. Lip137
Estimated H-index: 137
(University of Birmingham)
+ 3 AuthorsAlfonso Iorio39
Estimated H-index: 39
(McMaster University)
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...
Published on Aug 13, 2014in JAMA51.27
Ilpo Nuotio20
Estimated H-index: 20
(TYKS: Turku University Hospital),
Juha Hartikainen40
Estimated H-index: 40
+ 2 AuthorsK.E. Juhani Airaksinen44
Estimated H-index: 44
(TYKS: Turku University Hospital)
Published on Oct 1, 2013in International Journal of Cardiology3.47
K.E. Juhani Airaksinen44
Estimated H-index: 44
(TYKS: Turku University Hospital),
Petri Korkeila5
Estimated H-index: 5
(TYKS: Turku University Hospital)
+ 6 AuthorsJuhani Koistinen14
Estimated H-index: 14
(TYKS: Turku University Hospital)
Abstract Background Periprocedural management of oral anticoagulation (OAC) in patients undergoing cardiac rhythm management (CRM) device implantation is controversial. Prior studies demonstrate that uninterrupted OAC may be safe, but limited data from randomized trials exist. Methods We conducted a multicenter, randomized trial to evaluate the safety of uninterrupted OAC during CRM device implantation. Patients on long-term warfarin (N=213) treatment with contemporary indication for CRM device ...
Published on Oct 1, 2013in Europace6.10
Toni Grönberg4
Estimated H-index: 4
(TYKS: Turku University Hospital),
Ilpo Nuotio20
Estimated H-index: 20
(TYKS: Turku University Hospital)
+ 4 AuthorsK.E. Juhani Airaksinen44
Estimated H-index: 44
(TYKS: Turku University Hospital)
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...
Published on Oct 1, 2013in International Journal of Cardiology3.47
Stavros Apostolakis29
Estimated H-index: 29
(University of Birmingham),
Karl Georg Haeusler19
Estimated H-index: 19
(Charité)
+ 11 AuthorsAlexander Samol6
Estimated H-index: 6
(WWU: University of Münster)
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...
Published on Sep 1, 2013in Journal of the American College of Cardiology18.64
K.E. Juhani Airaksinen44
Estimated H-index: 44
(TYKS: Turku University Hospital),
Toni Grönberg4
Estimated H-index: 4
(TYKS: Turku University Hospital)
+ 4 AuthorsJuha Hartikainen40
Estimated H-index: 40
Objectives This study sought to explore the incidence and risk factors of thromboembolic complications after cardioversion of acute atrial fibrillation. Background Anticoagulation therapy is currently recommended after cardioversion of acute atrial fibrillation in patients with risk factors for stroke, but the implementation of these new consensus-based guidelines has been slow. Methods A total of 7,660 cardioversions were performed in 3,143 consecutive patients with atrial fibrillation lasting ...
Published on Nov 1, 2012in Internal Medicine Journal1.77
S. Lindberg1
Estimated H-index: 1
,
S. Hansen1
Estimated H-index: 1
,
T. Nielsen1
Estimated H-index: 1
Background/Aim We studied all patients admitted to hospital with first onset atrial fibrillation (AF) to determine the probability of spontaneous conversion to sinus rhythm and to identify factors predictive of such a conversion. Methods We retrospectively reviewed charts of 438 consecutive patients admitted to hospital with first onset AF from 1 January 2006 to 31 December 2009. The patients were divided into two groups, recent onset AF defined as AF 48 h. Results Spontaneous conversion occurre...
Published on Oct 1, 2012in Europace6.10
A. John Camm122
Estimated H-index: 122
,
Jeroen J. Bax85
Estimated H-index: 85
+ 14 AuthorsIsabelle C. Van Gelder67
Estimated H-index: 67
2012 focused update of the ESC Guidelines for the management of atrial fibrillation : An update of the 2010 ESC Guidelines for the management of atrial fibrillation: Developed with the special contribution of the European Heart Rhythm Association
Cited By12
Newest
Published on Feb 28, 2019in Scientific Reports4.01
Raluca Ileana Mincu1
Estimated H-index: 1
,
Amir A. Mahabadi22
Estimated H-index: 22
+ 1 AuthorsTienush Rassaf39
Estimated H-index: 39
Non-vitamin K antagonist oral anticoagulants (NOACs) have proven a favorable risk-benefit profile compared to vitamin K antagonists (VKAs) for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF), but actual data are not sufficiently powered to extend this profile on patients with AF that undergo cardioversion. We aimed to compare outcomes after cardioversion of AF under NOACs vs. VKAs. We systematically searched Pubmed, Cochrane, SCOPUS, and Web of Scie...
Published on Jul 1, 2019in Canadian Journal of Cardiology5.59
Paul Khairy55
Estimated H-index: 55
(MHI: Montreal Heart Institute)
Abstract The expanding population of adults with congenital heart disease (CHD) combined with the pervasiveness of arrhythmias has resulted in the rapid growth of a dedicated sector of cardiology at the intersection between two subspecialties: electrophysiology and adult CHD. Herein, practical considerations are offered regarding urgent referral for catheter ablation of atrial arrhythmias, anticoagulation, and primary prevention implantable cardioverter-defibrillators (ICDs). Patients with Ebste...
Published on Jun 1, 2019in Canadian Journal of Cardiology5.59
Jason G. Andrade23
Estimated H-index: 23
(UBC: University of British Columbia),
L. Brent Mitchell38
Estimated H-index: 38
(Libin Cardiovascular Institute of Alberta)
ABSTRACT The practice of electrical or pharmacological cardioversion (CV) to restore sinus rhythm in patents with symptomatic atrial fibrillation (AF) or atrial flutter (AFL) has been a part of clinical practice for over 100 years. For almost as long as CV has been performed, it has been recognised that the act of restoring sinus rhythm is associated with an increased risk of stroke and systemic embolism, and that oral anticoagulation (OAC) therapy can be used to prevent peri-CV thromboembolism....
Published on Jan 1, 2019in European Journal of Haematology2.22
Elise A. Larson (OHSU: Oregon Health & Science University), David German1
Estimated H-index: 1
(OHSU: Oregon Health & Science University)
+ 1 AuthorsThomas G. DeLoughery21
Estimated H-index: 21
(OHSU: Oregon Health & Science University)
Published on Nov 1, 2018in Canadian Journal of Cardiology5.59
Jason G. Andrade23
Estimated H-index: 23
(UBC: University of British Columbia),
Atul Verma51
Estimated H-index: 51
+ 22 AuthorsStuart J. Connolly89
Estimated H-index: 89
(McMaster University)
Abstract The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) ...
Published on Oct 3, 2018in Annals of Medicine3.05
Samuli Jaakkola2
Estimated H-index: 2
(TYKS: Turku University Hospital),
Tuomas Kiviniemi15
Estimated H-index: 15
(TYKS: Turku University Hospital),
K.E. Juhani Airaksinen44
Estimated H-index: 44
(TYKS: Turku University Hospital)
AbstractCardioversion is an essential component of rhythm control strategy for atrial fibrillation. The thromboembolic risk of cardioversion is well established and the mechanisms behind the phenom...
Published on Jun 1, 2018in Netherlands Heart Journal1.97
S. P. G. van Vugt2
Estimated H-index: 2
(Radboud University Nijmegen),
Marc A. Brouwer14
Estimated H-index: 14
(Radboud University Nijmegen)
In this manuscript, we discuss the most important changes in the field of anticoagulant treatment in patients with atrial fibrillation in the setting of electrical cardioversion or catheter ablation. Moreover, we provide practical guidance as well as information on daily practice.
Published on Apr 21, 2018in European Heart Journal23.24
Jan Steffel28
Estimated H-index: 28
,
Peter Verhamme34
Estimated H-index: 34
(Katholieke Universiteit Leuven)
+ 12 AuthorsVanessa Roldan-Schilling2
Estimated H-index: 2
(University of Murcia)
The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin...
Published on Feb 1, 2018in Herz0.99
J. W. Erath1
Estimated H-index: 1
(Goethe University Frankfurt),
Stefan H. Hohnloser98
Estimated H-index: 98
(Goethe University Frankfurt)
Atrial fibrillation (AF) is the most frequently encountered sustained arrhythmia with a prevalence of 0.5–10%, depending predominantly on age. The arrhythmia is associated with significant morbidity and mortality, mainly due to thromboembolic events including stroke and systemic embolisms. These complications can be effectively prevented with anticoagulation therapy either with vitamin K antagonists (VKA) or with non-vitamin K antagonists (NOAC). VKA therapy is effective in preventing strokes bu...
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