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Safety of electrical cardioversion in patients with previous embolic events
A Elhendy1, F Gentile, B K Khandheria
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Insights
Patients with atrial fibrillation or flutter and prior embolism face no increased thromboembolic risk from cardioversion with adequate anticoagulation. This ensures safe cardioversion procedures for high-risk patients.
Area of Science:
- Cardiology
- Neurology
Background:
- Cardioversion is a common procedure for atrial fibrillation or flutter.
- Patients with a history of embolic events are at higher risk for complications.
Purpose of the Study:
- To evaluate thromboembolic complications in patients with a history of embolism undergoing cardioversion for atrial fibrillation or flutter.
Main Methods:
- 104 patients with prior embolic events underwent 128 electrical cardioversions.
- Anticoagulation was administered in 92% of procedures.
- Successful cardioversion was the primary outcome.
Main Results:
- Cardioversion was successful in 84% of procedures.
- Only one embolic event (0.9%) occurred within 30 days post-cardioversion.
- The single event occurred in a patient with sub-therapeutic anticoagulation.
Conclusions:
- Adequate anticoagulation is crucial for preventing thromboembolic complications.
- Patients with previous embolism are not at increased risk if anticoagulation is sufficient.
- Cardioversion can be safely performed in these patients with proper management.
Objective:
To assess thromboembolic complications in cardioversions in patients with atrial fibrillation or flutter and a previous embolic event.
Patients And Methods:
The study population consisted of 104 patients with previous embolic events who underwent 128 electrical cardioversions for termination of atrial fibrillation or flutter. The primary outcome measure was successful cardioversion.
Results:
Anticoagulants were administered in 118 procedures (92%). Cardioversion was successful in 108 (84%) of the 128 procedures. Only 1 embolic event occurred within 30 days after cardioversion (incidence, 0.9% of successful procedures; 95 % confidence interval, 0.02%-5.3%). The single embolic event was a transient neurologic deficit occurring 22 days after cardioversion in a patient with previous atrial fibrillation. This patient had a sub-therapeutic level of anticoagulation. Transesophageal echocardiography revealed no spontaneous echo contrast or thrombi before the procedure. No thromboembolism was noted in patients who had therapeutic anticoagulation or in those with failed cardioversion.
Conclusion:
Patients with previous embolism are not at additional risk of thromboembolic complications after cardioversion if anticoagulation is adequate.