Can CHA2DS2-VASc Predict Recurrence of Atrial Fibrillation?

Veronica Hackethal, MD

Atrial fibrillation recurrence remains a challenge amidst significant advances in managing stroke risk. Could the CHA2DS2-VASc score help?

Can CHA2DS2-VASc Predict AF Recurrence?

Could a CHA2DS2-VASc Score Predict AF Recurrence? Research suggests the score may be a marker for atrial remodeling and physiologic changes that may both serve to trigger/perpetuate the arrhythmia.

Review and Pooled Meta-analysis. Data pooled for 2889 patients from 7 studies: 61% male, 50% with hypertension,  12% with diabetes, 23% with ischemic heart disease; median CHA2DS2-VASc score=2 (low stroke risk).

CHA2DS2-VASc Among Predictors of Early AF Recurrence. Other independent predictors of AF recurrence within 30 days post-cardioversion: Chronic kidney disease, peripheral artery disease, past ß-blocker use.

Cutoff for AF Recurrence: CHA2DS2-VASc ≥2. There was an observed 37% increased risk of AF recurrence with CHA2DS2-VASc score ≥ 2. Sensitivity, 64.8%; specificity 48.4%.

Take Home Points

  • Pooled meta-analysis suggests CHA2DS2-VASC score ≥ 2 may predict early AF recurrence after cardioversion in patients with low stroke risk, especially in CKD and PAD

  • First report of predictive value of CHA2DS2-VASc for AF recurrence in CKD

  • Less than ideal sensitivity, specificity and accuracy of CHA2DS2-VASc ≥ 2 for predicting AF recurrence
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