Timing of thromboembolic events after electical cardioversion of atrial fibrillation or flutter: a retrospective analysis

Berger, Marvin; Schweitzer, Paul

doi:10.1016/s0002-9149(98)00704-8

Cited by 196 publications

(100 citation statements)

References 33 publications

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“…Berger and Schweitzer 19 published a retrospective analysis of 4,621 patients undergoing elective DCCV, of whom 88 developed an embolic episode within 7 days and eight additional patients within 18 days. Of these 96 events, only three occurred in patients with duration of atrial fibrillation less than 48 hours.…”

Section: Discussionmentioning

confidence: 99%

“…25 A small minority were given single-dose periprocedural anticoagulation, but the utility of this practice is unclear. Thromboembolic events from conversion to normal sinus rhythm are known to occur up to 18 days after cardioversion, 19 related to stunning of the left atrial appendage, 26,27 so it is improbable that a single dose of anticoagulant would be protective. Of the 141 patients formally reviewed in our setting, only four were discharged with a documented new prescription for aspirin and three for coumadin, perhaps reflecting the low CHADS 2 score.…”

Section: Discussionmentioning

confidence: 99%

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Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Scheuermeyer

Grafstein

Stenstrom

et al. 2010

Academic Emergency Medicine

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Objectives: While the short-term (<7-day) safety and efficiency of electrical cardioversion for emergency department (ED) patients with atrial fibrillation or flutter have been established, the 30-day outcomes with respect to stroke, thromboembolic events, or death have not been investigated.Methods: A two-center cohort of consecutive ED patients undergoing cardioversion for atrial fibrillation or flutter between January 1, 2000, and September 30, 2007, was retrospectively investigated. This cohort was probabilistically linked with both a regional ED database and the provincial health registry to determine which patients had a subsequent ED visit or hospital admission, stroke, or thromboembolic event or died within 30 days. In addition, trained reviewers performed a detailed chart abstraction on 150 randomly selected patients, with emphasis on demographics, vital signs, medical treatment, and predefined adverse events. Hemodynamically unstable patients or those whose condition was the result of an underlying acute medical diagnosis were excluded. Data were analyzed by descriptive methods.Results: During the study period, 1,233 patients made 1,820 visits for atrial fibrillation or flutter to the ED. Of the 400 eligible patients undergoing direct-current cardioversion (DCCV), no patients died, had a stroke, or had a thromboembolic event in the following 30 days (95% confidence interval [CI] = 0.0 to 0.8% for all outcomes). A total of 141 patients were included in the formal chart review, with five patients (3.5%, 95% CI = 0.5% to 6.6%) failing cardioversion, six patients (4.3%, 95% CI = 0.9% to 7.6%) having a minor adverse event that did not change disposition, and five patients (3.5%, 95% CI = 0.5% to 6.6%) admitted to hospital at the index visit.Conclusions: Cardioversion of patients with atrial fibrillation or flutter in the ED appears to have a very low rate of long-term complications.ACADEMIC EMERGENCY MEDICINE 2010; 17:408-415 ª

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Scheuermeyer

Grafstein

Stenstrom

et al. 2010

Academic Emergency Medicine

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“…This conclusion has been supported by several other observational studies that found the risk of thromboembolism to be negligible (ranging from 0-0.9%) in patients who undergo cardioversion for AF of <48 hours from symptom onset. [14][15][16][17][18][19][20] More recently, the Fin-CV study examined over 3,000 patients with AF of estimated duration <48 hours who were cardioverted by either pharmacological or electrical intervention. 21 They confirmed that overall the risk of cardioverting patients with AF of <48 hours was low (0.7%), with 38 thromboembolic events occurring within 30 days following cardioversion.…”

Section: Risk Of Thromboembolism Following Cardioversionwhere Does Thmentioning

confidence: 99%

“…[14][15][16][17][18][19][20] Early rhythm control has the advantage of faster outcomes, improved symptom control and reduced hospital stay. 30,31 Furthermore, the longer a patient has AF, the more difficult it is to achieve successful cardioversion to sinus rhythm.…”

Section: Is Acute Rhythm Control Worth the Risk?mentioning

confidence: 99%

Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal

Rankin

2017

Clinical Medicine

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Current guidelines support the well-established clinical practice that patients who present with atrial fi brillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation. However, with increasing evidence that short runs of AF confer signifi cant risk of stroke, on what evidence is this 48-hour rule based and is it time to adopt a new approach? We review existing evidence and suggest a novel approach to risk stratifi cation in this setting. Overall, the risk of thromboembolism associated with acute cardioversion of patients with AF that is estimated to be of <48 hours duration is low. However, this risk varies widely depending on patient characteristics. From existing evidence, we show that using the CHA 2 DS 2 -VASc score may allow better selection of appropriate patients in order to prevent exposing specifi c patient groups to an unacceptably high risk of a potentially devastating complication. KEYWORDS : Anticoagulants , atrial fi brillation , cardioversion , electrical cardioversion , stroke , thromboembolism IntroductionInternational guidelines support the well-established clinical practice that patients who present with non-valvular atrial fibrillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation.1,2 The risk with more prolonged periods of AF is that restoration of sinus rhythm may precipitate embolism of intra-atrial thrombus causing stroke. However, with increasing evidence that even short runs of AF confer significant risk of stroke, [3][4][5][6] this review examines the evidence supporting the '48-hour rule' and suggests a novel approach to risk stratification in this setting. Search strategy and selection criteriaData for this review were identified by searches of PubMed using combinations of the terms 'atrial fibrillation', 'cardioversion' and 'thromboembolism'. References sourced ABSTRACTCardioverting acute atrial fi brillation and the risk of thromboembolism: not all patients are created equal from relevant articles were also included. Additional references were identified from review of current international guidelines on the management of atrial fibrillation.

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“…Оно наиболее выражено непосредственно после кардиоверсии; улуч-шение транспортной функции предсердий обычно происходит в течение нескольких дней, хотя иногда для этого требуется 3-4 нед в зависимости от длительности ФП [82,83]. Известно, что более 80% тромбоэмболий после кардиоверсии регистрируются в первые 3 дня и почти все -в течение 10 дней [84]. С помощью чрес-пищеводной ЭхоКГ подтверждено растворение тром-бов у большинства больных [85].…”

Section: патофизиология тромбообразованияunclassified

American College of Cardiology, American Heart Association and European Society of Cardiology (2006) Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Ryden²,

Cannom³

et al. 2007

Racionalʹnaâ farmakoterapiâ v kardiologii

120

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Отчет рабочей группы Американской коллегии кардиологов и Американской ассоциации сердца по практическим рекомендациям и комитета Европейского общества кардиологов по практическим рекомендациям Рекомендации разработаны в сотрудничестве с Европейской ассоциацией сердечного ритма и Обществом сердечного ритма Авторы (члены рабочей группы): V.

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Timing of thromboembolic events after electical cardioversion of atrial fibrillation or flutter: a retrospective analysis

Cited by 196 publications

References 33 publications

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal

American College of Cardiology, American Heart Association and European Society of Cardiology (2006) Guidelines for the Management of Patients With Atrial Fibrillation

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