Anticoagulation, CHA2DS2VASc Score, and Thromboembolic Risk of Cardioversion of Acute Atrial Fibrillation (from the FinCV Study) Toni Grönberg, BMa, Juha E.K. Hartikainen, MD, PhDb, Ilpo Nuotio, MD, PhDc, Fausto Biancari, MD, PhDd, Antti Ylitalo, MD, PhDe,f, and K.E. Juhani Airaksinen, MD, PhDe,* The efficacy of the anticoagulation in preventing thromboembolic complications (TEC) and the usefulness of the CHA2DS2VASc score for assessing stroke risk during cardioversion of acute atrial fibrillation (AF) are unclear. Thus, our objectives were to assess the ability of the CHA2DS2VASc 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 CHA2DS2VASc 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 CHA2DS2VASc score of 0 to 1 to 2.3% in those with score of ‡5 (p 18 years and living in the www.ajconline.org

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The American Journal of Cardiology (www.ajconline.org)

Table 1 Baseline characteristics of 7660 cardioversions according to the CHA2DS2VASc score CHA2DS2VASc score

Characteristic

Age (years) Women Heart failure Hypertension Diabetes mellitus Vascular disease Previous thromboembolism Implanted pacemaker First episode of atrial fibrillation Electrical cardioversion Duration of symptoms < 12 hours Ventricular rate of atrial fibrillation (bmp) Anticoagulation therapy Beta-blockers Class I antiarrhythmic drugs Class III antiarrhythmic drugs

P value

0-1 (n¼3362)

2 (n¼1610)

3-4 (n¼1997)

5-9 (n ¼ 691)

54.3  10.3 416 (12.4%) 33 (1.0%) 762 (22.7%) 24 (0.7%) 250 (7.4%) 0 102 (3.0%) 794 (23.6%) 2997 (89.1%) 1520 (45.2%) 108.5  26.9 590 (17.5%) 2293 (68.2%) 885 (26.3%) 130 (3.9%)

63.4  10.8 690 (42.9%) 54 (3.4%) 913 (56.7%) 124 (7.7%) 468 (29.1%) 36 (2.2%) 101 (6.3%) 315 (19.6%) 1445 (89.8%) 785 (48.8%) 109.6  25.1 516 (32.0%) 1327 (82.4%) 372 (23.1%) 73 (4.5%)

70.0  8.5 1174 (58.8%) 179 (9.0%) 1438 (72.0%) 361 (18.1%) 974 (48.8%) 241 (12.1%) 105 (5.3%) 445 (22.3%) 1826 (91.4%) 904 (45.3%) 111.1  33.4 852 (42.7%) 1688 (84.5%) 343 (17.2%) 77 (3.9%)

74.8  6.7 518 (75.0%) 137 (19.8%) 610 (88.3%) 233 (33.7%) 523 (75.7%) 419 (60.6%) 83 (12.0%) 141 (20.4%) 638 (92.3%) 334 (48.3%) 114.5  24.4 340 (49.2%) 601 (87.0%) 89 (12.9%) 45 (6.5%)

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