In 1995, practice guidelines recommended a limit of 48 hours after the onset of atrial fibrillation (AF) for cardioversion without anticoagulation. 1-3 Whether the risk of thromboembolic complications is increased when cardioversion without anticoagulation is performed in less than 48 hours is unknown.
The incidence of post-cardioversion thromboembolic complications is high in certain subgroups of patients when no anticoagulation is used after cardioversion of acute atrial fibrillation. (Safety of Cardioversion of Acute Atrial Fibrillation [FinCV]; NCT01380574).
Bradycardic complications are rare and usually benign after cardioversion of acute AF. They seem to reflect sinus node dysfunction and often result in later implantation of a permanent pacemaker.
The risk of TEC increases substantially in patients >75 and ECVs ≥12 h, particularly in women. Time to cardioversion should be added to risk-stratification of ECVs of acute AF. Key messages The ideal timing of cardioversion is still unknown and not based on solid evidence. Delay to cardioversion ≥12 h should be added to the risk stratification of atrial fibrillation cardioversion. Female sex increases the risk of complications and failure of cardioversion after electrical cardioversion of atrial fibrillation <48 h, especially with age >75 years and time to cardioversion exceeding 12 h.
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