Accurate risk stratification is considered the first and most important step in the management of patients with non-valvular atrial fibrillation (NVAF). We compared the performance of the widely used CHA2DS2-VASc and the recently developed R2CHADS2 and ATRIA scores, for predicting thromboembolic (TE) event in either non-anticoagulated or anticoagulated patients with NVAF. The non-anticoagulated cohort was comprised of 154 patients, whereas 911 patients formed the cohort of patients on vitamin-K-antagonist. The scores were computed using the criteria mentioned in their developmental cohorts. Measures of performance for the risk scores were evaluated at predicting TE event. In the non-anticoagulated cohort, 9 TE events occurred during 11 ± 2.7 months. CHA2DS2-VASc showed significant association with TE occurrence: hazard ratio (HR) = 1.58 (95 % confidence interval [95 % IC] 1.01–2.46), but R2CHADS2 and ATRIA did not (HR = 1.23 (95 % CI 0.86–1.77) and 1.20 (95 % CI 0.93–1.56), respectively. In the anticoagulated cohort, after 10 ± 3 months of follow up, 18 TE events were developed. In that cohort, the three scores showed similar association with TE risk: HR = 1.49 (95 % CI 1.13–1.97), 1.41 (95 % CI 1.13–1.77) and 1.37 (95 % CI 1.12–1.66) for CHA2DS2-VASc, R2CHADS2 and ATRIA, respectively. In both cohorts, no TE event occurred in patients classified in the low risk category according to CHA2DS2-VASc or R2CHADS2. In this study of NVAF patients, CHA2DS2-VASc has better association with TE events than the new R2CHADS2 and ATRIA risk scores in the non-anticoagulated cohort. CHA2DS2-VASc and R2CHADS2 can identify patients at truly low risk regardless of the anticoagulation status.

Background: Electrophysiological studies and ablation procedures are the most prevalent activities in electrophysiology. However, device implantation represents a great deal of the daily activity. In several European regions, aging populations are becoming a big concern, not only increasing the number of pacemakers implantations but also raising the age threshold for implantation. Purpose: Assessment of survival rates after device implantations on patients over ninety years of age. Are there any markers that could help us infer survival rates? How prevalent are complications? What key performance indicators should be paying attention to? Methods: Observational retrospective study of a cohort of 903 patients referred to the arrhythmia unit of our institution for pacemaker implantation, during the period from 2016 to 2019. Cox regression analysis performed over that cohort. Hazard-ratio (HR) and confidence intervals (CI 95%)calculated. Survival curves represented with Kaplan-Meier method and statistical significance estimated with log-rank test. Results: Out of the 903 patients, 82 (9.1%) are nonagenarians. Follow-up was 3.97 ± 4.98 years. The mean age at the time of pacemaker implantation was 78.94 ± 10.11 years. Some complications were observed in 9.9% of patients under 90 years of age, compared to 4.9% in those over that age. At the time of the follow-up, 82.5% of the patients were alive. In the univariate analysis, the following predictors of mortality were identified: age; atrial fibrillation (AF); renal function; anemia; comorbidity, estimated by Charlson score; underlying heart disease; type of pacemaker implanted; and, whether the patient was institutionalized. In the multivariate analysis, the following were independent predictors of mortality: age (HR 1.129; 95% CI 1.1-1.159; p<0.001), comorbidity reflected as a Charlson score ≥ 5 (HR 4.116; 95% CI 2.349 -7.212; p<0.001); heart disease (HR 2.496; 95% CI 1.725-3.612; p<0.001); institutionalization of the patient (HR 2.794; 95% CI 1.632-4.783; p<0.001); and the single-chamber pacemaker (HR 2.201; 95% CI 1.455-3.329; p<0.001). In the group of nonagenarian patients, the univariate analysis showed the following variables as predictors of lower survival: age; serum creatinine; comorbidity, estimated by the Charlson score; and, underlying heart disease. In the multivariate analysis, the following were identified as independent predictors of mortality: comorbidity, reflected as a Charlson score ≥ 5 (HR 7.299; 95% CI 2.468-21.589; p90 y.o.Survival curves K-M