Yonsei Med J.  2018 Mar;59(2):236-242. 10.3349/ymj.2018.59.2.236.

CHAâ‚‚DSâ‚‚-VASc Score in the Prediction of Ischemic Stroke in Patients after Radiofrequency Catheter Ablation of Typical Atrial Flutter

Affiliations
  • 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac

Abstract

PURPOSE
Despite undergoing successful catheter ablation of typical atrial flutter (AFL), patients remain at increased risk for ischemic stroke. However, data on risk prediction tools for the development of stroke after AFL ablation are lacking. This study investigates whether CHAâ‚‚DSâ‚‚-VASc score is useful for predicting ischemic stroke after successful ablation of typical AFL.
MATERIALS AND METHODS
A total of 293 patients (236 men, mean age 56.1±13.5 years) who underwent successful radiofrequency catheter ablation for typical AFL were included in this study. The clinical end point was occurrence of ischemic stroke during follow-up after AFL ablation.
RESULTS
During the follow-up period (60.8±45.9 months), ischemic stroke occurred in 18 (6%) patients at a median of 34 months (interquartile range, 13-65 months). CHAâ‚‚DSâ‚‚-VASc score [hazard ratio 2.104; 95% confidence interval (CI), 1.624-2.726; p < 0.001] was an independent predictor for the occurrence of stroke after AFL ablation. The area under the receiver operating characteristic curve for CHAâ‚‚DSâ‚‚-VASc score was 0.798 (95% CI, 0.691-0.904). The CHAâ‚‚DSâ‚‚-VASc score could be used to stratify patients into two groups with different incidences of ischemic stroke (1.6% vs. 14.4%, p < 0.001) at a cutoff value of 2.
CONCLUSION
CHAâ‚‚DSâ‚‚-VASc score is useful in a prediction model for the risk of stroke after catheter ablation of typical AFL.

Keyword

Atrial flutter; atrial fibrillation; stroke; catheter ablation; CHAâ‚‚DSâ‚‚-VASc score

MeSH Terms

Aged
Aged, 80 and over
Atrial Flutter/*surgery
Brain Ischemia/epidemiology/*etiology
Catheter Ablation/*adverse effects
Female
Follow-Up Studies
Humans
Incidence
Middle Aged
Postoperative Complications/*epidemiology
Predictive Value of Tests
Prognosis
Proportional Hazards Models
ROC Curve
Risk Assessment/*methods
Seoul/epidemiology
Stroke/epidemiology/*etiology
Treatment Outcome

Figure

  • Fig. 1 Flow chart of the study population. *6 patients had VHD and AF, †2 patients had VHD, AF, and dilated cardiomyopathy, ‡1 patient had AF and hypertrophic cardiomyopathy. AFL, atrial flutter; AF, atrial fibrillation; VHD, valvular heart disease.

  • Fig. 2 Graded increase in incidence of stroke by CHA2DS2-VASc score. CHA2DS2-VASc score, congestive heart failure, hypertension, age, diabetes mellitus, history of stroke or transient ischemic attack score, vascular disease and sex category.

  • Fig. 3 ROC curve for CHA2DS2-VASc score predicting ischemic stroke after AFL ablation. The AUC for CHA2DS2-VASc score for predicting event was 0.798. At a best cutoff of 2, the sensitivity and specificity for stroke event were 83.3% and 67.6%, respectively. AUC, area under the curve; CHA2DS2-VASc score, congestive heart failure, hypertension, age, diabetes mellitus, history of stroke or transient ischemic attack score, vascular disease and sex category; ROC, receiver operating characteristic.

  • Fig. 4 Stroke free survival curves for patients with different CHA2DS2-VASc scores. Kaplan-Meier survival analysis demonstrated that patients with a CHA2DS2-VASc scores ≥2 had a higher event rate compared with patients with a CHA2DS2-VASc score <2 (14.4% vs. 1.6%, p<0.001). CHA2DS2-VASc score, congestive heart failure, hypertension, age, diabetes mellitus, history of stroke or transient ischemic attack score, vascular disease and sex category.


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