Frontiers in cardiovascular medicine · 2025
Usability of CHA2DS2VASC score in predicting the effectiveness and safety of pharmacological cardioversion - data from the multicenter cardioversion with intravenous ANTazoline study.
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Krzowski Bartosz, Ozierański Krzysztof, Peller Michał, Wróbel Wojciech, Miśkowiec Dawid, Ćwiek-Rębowska Edyta, Maciąg Aleksander, Farkowski Michał, Szołkiewicz Marek, Ceynowa-Sielawko Beata, Koziński Marek, Wójcik Maciej, Błaszczyk Robert, Szwed Hanna, Kasprzak Jarosław, Mizia-Stec Katarzyna, Wybraniec Maciej, Balsam Paweł
Аннотация
BACKGROUND: Pharmacological cardioversion (PCV) is one of the therapeutic options within rhythm control strategies for atrial fibrillation (AF). Data on clinical determinants influencing its effectiveness and safety in real-world settings remain limited.
METHODS: This study is a sub-analysis of the multicenter Cardioversion with Intravenous Antazoline in Atrial Fibrillation II (CANT II) registry. The registry retrospectively included consecutive patients with recent-onset AF undergoing urgent PCV in six Polish centers between 2019 and 2020. We analyzed 931 patients stratified according to CHA₂DS₂-VASc score: Group I (0-1 points; n = 194), Group II (2-4 points; n = 580), and Group III (≥5 points; n = 157). The primary endpoint was successful restoration of sinus rhythm within 12 h, and the secondary endpoint was a composite of adverse events (death, syncope, bradycardia, hypotension).
RESULTS: The median age was 69 years, 48% were men, and the median CHA₂DS₂-VASc score was 3. Antazoline was used in 59% of patients, amiodarone in 53%, and propafenone in 19%. Sinus rhythm was restored in 69%, 70%, and 64% of patients in Groups I, II, and III, respectively (p = 0.45). The overall adverse event rate was low (2.1%) and did not differ significantly between groups (p = 0.16). Antazoline was most effective in Group I, while propafenone showed higher efficacy in Group II.
CONCLUSIONS: In this retrospective sub-analysis of the CANT II registry, success of pharmacological cardioversion of AF is not associated with number of comorbidities as assessed by the CHA2DS2VASc score. PCV remains a feasible and generally safe option in emergency and cardiology department practice.
METHODS: This study is a sub-analysis of the multicenter Cardioversion with Intravenous Antazoline in Atrial Fibrillation II (CANT II) registry. The registry retrospectively included consecutive patients with recent-onset AF undergoing urgent PCV in six Polish centers between 2019 and 2020. We analyzed 931 patients stratified according to CHA₂DS₂-VASc score: Group I (0-1 points; n = 194), Group II (2-4 points; n = 580), and Group III (≥5 points; n = 157). The primary endpoint was successful restoration of sinus rhythm within 12 h, and the secondary endpoint was a composite of adverse events (death, syncope, bradycardia, hypotension).
RESULTS: The median age was 69 years, 48% were men, and the median CHA₂DS₂-VASc score was 3. Antazoline was used in 59% of patients, amiodarone in 53%, and propafenone in 19%. Sinus rhythm was restored in 69%, 70%, and 64% of patients in Groups I, II, and III, respectively (p = 0.45). The overall adverse event rate was low (2.1%) and did not differ significantly between groups (p = 0.16). Antazoline was most effective in Group I, while propafenone showed higher efficacy in Group II.
CONCLUSIONS: In this retrospective sub-analysis of the CANT II registry, success of pharmacological cardioversion of AF is not associated with number of comorbidities as assessed by the CHA2DS2VASc score. PCV remains a feasible and generally safe option in emergency and cardiology department practice.