GERARDO MAZZELLA

 GERARDO MAZZELLA

Heart Rhythm

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CLINICAL ATRIAL FIBRILLATION| VOLUME 15, ISSUE 7, P971-979, JULY 01, 2018

Does the CHA2DS2-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices

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Does the CHA2DS2-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices

Giovanni Rovaris, MD 

Francesco Solimene, MD

Antonio D'Onofrio, MD

Daniele Giacopelli, MSc

Alessio Gargaro, MSc

Ennio C. Pisanò, MD

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Published:February 22, 2018DOI:https://doi.org/10.1016/j.hrthm.2018.02.023

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Background

CHA 2DS 2-VASc is a validated score for predicting stroke in patients with atrial fibrillation (AF).

Objective

The purpose of this study was to assess whether the CHA 2DS 2-VASc score can predict new-onset AF in a cohort of patients with a cardiac implantable electronic device (CIED) followed with remote monitoring.

Methods

Using the database of the Home Monitoring Expert Alliance project, we selected 2410 patients with no documented AF who had received a CIED with diagnostics on atrial high rate episodes (AHREs). The primary endpoint was time to first day with cumulative AHRE burden ≥15 minutes, 5 hours, 24 hours, and ≥7 consecutive days.

Results

During a median duration of 24.1(11.5–42.9) months, the incidence of AHRE increased with increasing CHA 2DS 2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA 2DS 2-VASc ≤1) vs 93.7% (CHA 2DS 2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA 2DS 2-VASc ≤1) vs 92.5% (CHA 2DS 2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA 2DS 2-VASc: 9.1% and 3.9% (CHA 2DS 2-VASc ≤1) vs 40.4% and 28.7% (CHA 2DS 2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA 2DS 2-VASc increase ranged from 1.09 (confidence interval 1.04–1.14; P <.001) with AHRE burden ≥15 minutes to 1.26 (confidence interval 1.11–1.42; P <.001) with AHRE burden ≥7 days. At receiver operating curve analysis, CHA 2DS 2-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA 2DS 2-VASc ≥5 had 77.0% specificity but 34.6% sensitivity.

Conclusion

In a CIED population with no previous diagnosis of clinical AF, AHRE incidence increased with increasing CHA 2DS 2-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA 2DS 2-VASc as AHRE predictor was moderate.


GERARDO MAZZELLA

Keywords

Atrial fibrillation

Cardiac implantable electronic device

CHA2DS2-VASc score

Clinical predictor

Remote monitoring

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Article Info

Publication History

Published online: February 22, 2018

Footnotes

Data collection and analysis were performed in the framework of the Home Monitoring Expert Alliance (HMEA), an investigator-initiated nationwide repository of data. Technical and logistical support necessary for this research was provided by BIOTRONIK Italia, which is not the sponsor of the study and does not provide grants or fees per patient. Mr. Giacopelli and Mr. Gargaro are employees of BIOTRONIK Italia. All other authors have reported that they have no conflicts relevant to the contents of this paper to disclose.


Identification

DOI: https://doi.org/10.1016/j.hrthm.2018.02.023


Copyright

© 2018 Published by Elsevier Inc. on behalf of Heart Rhythm Society.

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