AUTHOR=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 

TITLE=Usability of CHA2DS2VASC score in predicting the effectiveness and safety of pharmacological cardioversion – data from the multicenter cardioversion with intravenous ANTazoline study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1648549

DOI=10.3389/fcvm.2025.1648549

ISSN=2297-055X

ABSTRACT=BackgroundPharmacological 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.MethodsThis 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).ResultsThe 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.ConclusionsIn 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.