CHA2DS2-VASc Score Predicts Atrial Fibrillation Recurrence After Cardioversion: Systematic Review and Individual Patient Pooled Meta-analysis

Overview

Journal Clin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2019 Jan 1

PMID 30597581

Citations 15

Authors

Francesco Vitali

Matteo Serenelli

Juhani Airaksinen

Rita Pavasini

Anna Tomaszuk-Kazberuk

Elzbieta Mlodawska

Samuli Jaakkola

Cristina Balla

Lorenzo Falsetti

Nicola Tarquinio

Roberto Ferrari

Angelo Squeri

Gianluca Campo

Matteo Bertini

Affiliations

Soon will be listed here.

Abstract

Background: Despite progresses in the treatment of the thromboembolic risk related to atrial fibrillation (AF), the management of recurrences remains a challenge.

Hypothesis: To assess if congestive heart failure or left ventricular systolic dysfunction (CHA DS -VASc) score is predictive of early arrhythmia recurrence after AF cardioversion.

Methods: Systematic review and individual patient pooled meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Inclusion Criteria: observational trials in patients with AF undergoing cardioversion, available data on recurrence of AF and available data on CHA DS -VASc score. Clinical studies of interest were retrieved by PubMed, Cochrane Library, and Biomed Central. Seven authors were contacted for joining the patient level meta-analysis, and three shared data regarding anthropometric measurements, risk factors, major comorbidities, and CHA DS -VASc score. The primary outcome was the recurrence of AF after cardioversion in patients free from antiarrhythmic prophylaxis. Univariate and multivariate logistic regression was performed.

Results: Overall, we collect data of 2889 patients: 61% were male, 50% with hypertension, 12% with diabetes, and 23% with history of ischemic heart disease. The median CHA2DS2-VASc score was 2.. At the multivariate analysis, chronic kidney disease (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.12-3.27; P = 0.01), peripheral artery disease (OR 1.65; 95% CI 1.23-2.19; P < 0,0001), previous use of beta blockers (OR 1.5; 95% CI 1.19-1.88; P < 0.0001), and CHA2DS2-VASc score > 2 (OR 1.37; 95% CI 1.1-1.68; P = 0.002) were independent predictors of early recurrence of AF.

Conclusions: CHA2DS2-VASc score predicts early recurrence of AF in the first 30 days after electrical or pharmacological cardioversion. Protocol registration PROSPERO (CRD42017075107).

Citing Articles

Predictive ability of serum osmolarity for contrast-induced nephropathy after elective percutaneous coronary intervention: Are we having a new target?.

Samir A, Radwan A, Elhossary H, Baghdady Y Egypt Heart J. 2025; 77(1):22.

PMID: 39982663 PMC: 11845326. DOI: 10.1186/s43044-025-00620-8.

Predictive Value of N-Terminal Pro B-Type Natriuretic Peptide for Short-Term Outcome of Cardioversion in Patients with First-Diagnosed or Paroxysmal Atrial Fibrillation Presenting to the Emergency Department.

Diakantonis A, Verras C, Bezati S, Bistola V, Ventoulis I, Velliou M Biomedicines. 2025; 12(12.

PMID: 39767800 PMC: 11727096. DOI: 10.3390/biomedicines12122895.

Echocardiographic Assessment of Left Atrial Mechanics in Patients with Atrial Fibrillation Undergoing Electrical Cardioversion: A Systematic Review.

Sonaglioni A, Nicolosi G, Bruno A, Lombardo M, Muti P J Clin Med. 2024; 13(21).

PMID: 39518435 PMC: 11546254. DOI: 10.3390/jcm13216296.

The Risk of Atrial Fibrillation and Previous Ischemic Stroke in Cognitive Decline.

Pal T, Baba D, Preg Z, Nemes-Nagy E, Nyulas K, German-Sallo M J Clin Med. 2024; 13(14).

PMID: 39064156 PMC: 11277964. DOI: 10.3390/jcm13144117.

Association between triglyceride-glucose index trajectories and radiofrequency ablation outcomes in patients with stage 3D atrial fibrillation.

Jia S, Yin Y, Mou X, Zheng J, Li Z, Hu T Cardiovasc Diabetol. 2024; 23(1):121.

PMID: 38581024 PMC: 10998403. DOI: 10.1186/s12933-024-02219-w.

References

Kirchhof P, Breithardt G, Camm A, Crijns H, Kuck K, Vardas P . Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial. Am Heart J. 2013; 166(3):442-8. DOI: 10.1016/j.ahj.2013.05.015. View

Vitali F, Serenelli M, Airaksinen J, Pavasini R, Tomaszuk-Kazberuk A, Mlodawska E . CHA2DS2-VASc score predicts atrial fibrillation recurrence after cardioversion: Systematic review and individual patient pooled meta-analysis. Clin Cardiol. 2019; 42(3):358-364. PMC: 6712331. DOI: 10.1002/clc.23147. View

de Denus S, Sanoski C, Carlsson J, Opolski G, Spinler S . Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis. Arch Intern Med. 2005; 165(3):258-62. DOI: 10.1001/archinte.165.3.258. View

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38):2893-2962. DOI: 10.1093/eurheartj/ehw210. View

Saliba W, Gronich N, Barnett-Griness O, Rennert G . Usefulness of CHADS2 and CHA2DS2-VASc Scores in the Prediction of New-Onset Atrial Fibrillation: A Population-Based Study. Am J Med. 2016; 129(8):843-9. DOI: 10.1016/j.amjmed.2016.02.029. View

Melloni C, Shrader P, Carver J, Piccini J, Thomas L, Fonarow G . Management and outcomes of patients with atrial fibrillation and a history of cancer: the ORBIT-AF registry. Eur Heart J Qual Care Clin Outcomes. 2017; 3(3):192-197. DOI: 10.1093/ehjqcco/qcx004. View

Chamberlain A, Agarwal S, Folsom A, Duval S, Soliman E, Ambrose M . Smoking and incidence of atrial fibrillation: results from the Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm. 2011; 8(8):1160-6. PMC: 3139831. DOI: 10.1016/j.hrthm.2011.03.038. View

Stroup D, Berlin J, Morton S, Olkin I, Williamson G, Rennie D . Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000; 283(15):2008-12. DOI: 10.1001/jama.283.15.2008. View

Kotecha D, Kirchhof P . Rate and rhythm control have comparable effects on mortality and stroke in atrial fibrillation but better data are needed. Evid Based Med. 2014; 19(6):222-3. DOI: 10.1136/ebmed-2014-110062. View

10.

Psaty B, Manolio T, Kuller L, Kronmal R, Cushman M, Fried L . Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997; 96(7):2455-61. DOI: 10.1161/01.cir.96.7.2455. View

11.

Haissaguerre M, Jais P, Shah D, Takahashi A, Hocini M, Quiniou G . Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998; 339(10):659-66. DOI: 10.1056/NEJM199809033391003. View

12.

Wyse D, Waldo A, DiMarco J, Domanski M, Rosenberg Y, Schron E . A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347(23):1825-33. DOI: 10.1056/NEJMoa021328. View

13.

Norby F, Soliman E, Chen L, Bengtson L, Loehr L, Agarwal S . Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up: The ARIC Study (Atherosclerosis Risk in Communities). Circulation. 2016; 134(8):599-610. PMC: 4999250. DOI: 10.1161/CIRCULATIONAHA.115.020090. View

14.

Aribas A, Akilli H, Gul E, Kayrak M, Demir K, Duman C . Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?. Anadolu Kardiyol Derg. 2012; 13(2):123-30. DOI: 10.5152/akd.2013.036. View

15.

Aboyans V, Ricco J, Bartelink M, Bjorck M, Brodmann M, Cohnert T . 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric,.... Eur Heart J. 2017; 39(9):763-816. DOI: 10.1093/eurheartj/ehx095. View

16.

ONeal W, Efird J, Nazarian S, Alonso A, Heckbert S, Soliman E . Peripheral arterial disease and risk of atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2014; 3(6):e001270. PMC: 4338716. DOI: 10.1161/JAHA.114.001270. View

17.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

18.

DerSimonian R, Laird N . Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015; 45(Pt A):139-45. PMC: 4639420. DOI: 10.1016/j.cct.2015.09.002. View

19.

Guerra F, Scappini L, Maolo A, Campo G, Pavasini R, Shkoza M . CHADS-VASc risk factors as predictors of stroke after acute coronary syndrome: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2016; 7(3):264-274. DOI: 10.1177/2048872616673536. View

20.

Kong M, Shaw L, OConnor C, Califf R, Blazing M, Al-Khatib S . Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure?. Ann Noninvasive Electrocardiol. 2010; 15(3):209-17. PMC: 6932071. DOI: 10.1111/j.1542-474X.2010.00365.x. View