Embolic complications of direct current cardioversion of atrial arrhythmias: association with low intensity of anticoagulation at the time of cardioversion.
نویسندگان
چکیده
OBJECTIVES The goal of this study was to identify the factors responsible for embolic complications of direct current (DC) cardioversion of atrial arrhythmias. BACKGROUND Direct current cardioversion of atrial fibrillation (AF) carries a risk of thromboembolism, which is reduced, but not eliminated, by anticoagulation. The risk of embolism after conversion of atrial flutter is believed to be lower. No series to date has included enough patients receiving anticoagulants or enough patients with atrial flutter to estimate the risk in these groups. METHODS We reviewed the case records of 1,950 patients who underwent 2,639 attempts at DC cardioversion. RESULTS Cardioversion was performed within two days of the apparent onset of the arrhythmia in 443 episodes, 352 without subsequent prolonged anticoagulation with one embolic complication. Cardioversion was preceded by warfarin therapy for > or = 3 weeks in 1,932 instances. No embolic complication occurred in 779 attempts performed with an international normalized ratio (INR) of > or = 2.5 (95% confidence limits 0% to 0.48%). Of 756 cases in which the INR was <2.5 or was not measured before conversion, nine were complicated by thromboembolism. Embolism was significantly more common at an INR of 1.5 to 2.4 than at an INR > or = 2.5 (0.93% vs. 0%, p = 0.012). The incidence of embolism after conversion of atrial flutter or tachycardia was similar to that after cardioversion of AF (0.72% vs. 0.46%, p = NS). CONCLUSIONS The INR should be > or = 2.5 at the time of cardioversion if the duration of AF is uncertain or >2 days. Cardioversion of atrial flutter presents similar risks and requires similar anticoagulation.
منابع مشابه
Atrial Fibrillation Embolic Complications of Direct Current Cardioversion of Atrial Arrhythmias: Association With Low Intensity of Anticoagulation at the Time of Cardioversion
OBJECTIVES The goal of this study was to identify the factors responsible for embolic complications of direct current (DC) cardioversion of atrial arrhythmias. BACKGROUND Direct current cardioversion of atrial fibrillation (AF) carries a risk of thromboembolism, which is reduced, but not eliminated, by anticoagulation. The risk of embolism after conversion of atrial flutter is believed to be lo...
متن کاملEmbolic Events in Patients With Atrial Fibrillation and Effective Anticoagulation: Value of Transesophageal Echocardiography to Guide Direct-Current Cardioversion
OBJECTIVES The primary objective was to evaluate the usefulness of transesophageal echocardiography (TEE)-guided cardioversion to prevent thromboembolic complications in patients with atrial fibrillation (AF) and effective anticoagulation (International Normalized Ratio of 2 or 3) at least three weeks before cardioversion. BACKGROUND Transesophageal echocardiography has been proposed as a metho...
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Coronary embolism with acute myocardial infarction (MI) following direct-current (DC) cardioversion of atrial fibrillation (AF) has rarely been reported. We present the case of a 34-year-old female with severe aortic regurgitation and highly symptomatic paroxysmal AF. Acute embolic MI occurred 4 days after DC cardioversion of AF, although there was no left atrial thrombus detected before this p...
متن کاملA review of direct current cardioversions for atrial arrhythmia.
UNLABELLED The risk of arterial embolism is well recognised following Direct Current Cardioversion (DCC) for atrial fibrillation although the use of prophylactic anticoagulation remains controversial. AIM To determine the risk of arterial embolism post-cardioversion and which factors predict successful cardioversion and maintenance of sinus rhythm. MATERIALS AND METHODS A retrospective stud...
متن کاملHigh intensity anticoagulation for cardioversion of atrial arrhythmias? The shocking truth.
Direct current (DC) cardioversion is now a common, accepted, outpatient procedure that treats a growing number of patients with symptomatic atrial flutter and atrial fibrillation (AF), but complications can occur. Stroke following cardioversion is the most feared consequence of this beneficial and effective therapy. Thromboemboli are a known complication of chronic AF, and acute reversion of AF...
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عنوان ژورنال:
- Journal of the American College of Cardiology
دوره 40 5 شماره
صفحات -
تاریخ انتشار 2002