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[Cardioversion in atrial fibrillation]
Philippe Ricard1, Manuel Imianitoff, Nadir Saoudi
1Service de cardiologie Centre hospitalier Princesse Grace 98000 Monaco. PHILRICARD@aol.com
Insights
Electrical cardioversion is the preferred method for long-term atrial fibrillation, with success rates up to 96%. Anticoagulation or heparin can prevent embolic complications during cardioversion.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) management involves cardioversion.
- Two primary methods exist: pharmacological and electrical.
Purpose of the Study:
- To outline current strategies for cardioversion of atrial fibrillation.
- To discuss methods for preventing embolic complications.
Main Methods:
- Review of pharmacological and electrical cardioversion techniques.
- Discussion of anticoagulation strategies for embolic prevention.
Main Results:
- Pharmacological cardioversion is effective for short-duration AF (<7 days).
- Electrical external cardioversion is preferred for long-duration AF, with success rates of 64-96%.
- Biphasic waveform defibrillators improve success rates.
- Internal cardioversion is an option if external fails.
- Both 3-week warfarin anticoagulation and 2-day heparin (if no thrombus) are effective for embolic prevention.
Conclusions:
- Electrical cardioversion is highly effective for established atrial fibrillation.
- Appropriate anticoagulation is crucial for safe cardioversion and prevention of stroke.
Abstract:
For cardioversion of atrial fibrillation 2 techniques are available: pharmacological and electrical. Pharmacological cardioversion is effective, especially when the duration of arrhythmia is shorter than 7 days. In contrast, for long duration of fibrillation electrical external cardioversion is the technique of choice. The success rate ranges from 64 to 96%. The development of new defibrillators delivering biphasic waveforms is associated with an increase in the success rate of cardioversion. For patients where external cardioversion has failed, internal cardioversion should be proposed. One major concern is prevention of embolic complications. For this purpose 2 strategies are equally effective: 1.3-week anticoagulation with warfarin; 2. short-duration (2 days) heparin treatment is sufficient if the presence of a left atrial thrombus has been ruled out with a transoesophageal echocardiocardiogram.