Giovanni Rovaris1, Francesco Solimene2, Antonio D'Onofrio3, Gabriele Zanotto4, Renato P Ricci5, Tiziana Mazzella6, Saverio Iacopino7, Paolo Della Bella8, Giampiero Maglia9, Gaetano Senatore10, Fabio Quartieri11, Mauro Biffi12, Antonio Curnis13, Valeria Calvi14, Antonio Rapacciuolo15, Matteo Santamaria16, Alessandro Capucci17, Massimo Giammaria18, Andrea Campana19, Fabrizio Caravati20, Daniele Giacopelli21, Alessio Gargaro21, Ennio C Pisanò6. 1. Ospedale San Gerardo, Monza, Italy. Electronic address: gi.rovaris@tin.it. 2. Clinica Montevergine, Mercogliano (AV), Italy. 3. Ospedale Monaldi, Napoli, Italy. 4. Ospedale Mater Salutis, Legnago, Italy. 5. Roma, Italy. 6. Ospedale Vito Fazzi, Lecce, Italy. 7. Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy. 8. Ospedale San Raffaele, Milano, Italy. 9. Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy. 10. Ospedale di Ciriè, Ciriè (TO), Italy. 11. Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 12. Policlinico Sant'Orsola-Malpighi, Bologna, Italy. 13. Spedali Civili, Brescia, Italy. 14. Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy. 15. Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy. 16. Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy. 17. Clinica di Cardiologia, Università Politecnica Marche, Ancona, Italy. 18. Ospedale Maria Vittoria, Torino, Italy. 19. AOU S.Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy. 20. Ospedale di Circolo e Fond. Macchi, Varese, Italy. 21. BIOTRONIK Italia, Vimodrone (MI), Italy.
Abstract
BACKGROUND: CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA2DS2-VASc ≤1) vs 93.7% (CHA2DS2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA2DS2-VASc ≤1) vs 92.5% (CHA2DS2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA2DS2-VASc: 9.1% and 3.9% (CHA2DS2-VASc ≤1) vs 40.4% and 28.7% (CHA2DS2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA2DS2-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, CHA2DS2-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA2DS2-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 CHA2DS2-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA2DS2-VASc as AHRE predictor was moderate.
BACKGROUND: CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA2DS2-VASc ≤1) vs 93.7% (CHA2DS2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA2DS2-VASc ≤1) vs 92.5% (CHA2DS2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA2DS2-VASc: 9.1% and 3.9% (CHA2DS2-VASc ≤1) vs 40.4% and 28.7% (CHA2DS2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA2DS2-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, CHA2DS2-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA2DS2-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 CHA2DS2-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA2DS2-VASc as AHRE predictor was moderate.
Authors: Guido Galletti; Fortunato Alfonsi; Angelo Raffaele; Nicola Alberto Valente; Sibylle Chatelain; Roni Kolerman; Chiara Cinquini; Stefano Romeggio; Giovanna Iezzi; Antonio Barone Journal: Int J Environ Res Public Health Date: 2020-06-26 Impact factor: 3.390
Authors: Vincenzo Russo; Antonio Rapacciuolo; Anna Rago; Vincenzo Tavoletta; Stefano De Vivo; Giuseppe Ammirati; Valerio Pergola; Giovanni Domenico Ciriello; Paola Napoli; Gerardo Nigro; Antonio D'Onofrio Journal: J Arrhythm Date: 2022-02-13
Authors: Vincenzo Russo; Anna Rago; Vincenzo Tavoletta; Valter Bianchi; Cristina Carella; Giuseppe Ammirati; Aniello Viggiano; Stefano De Vivo; Antonio Rapacciuolo; Gerardo Nigro; Antonio D'Onofrio Journal: J Atr Fibrillation Date: 2018-08-31