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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Low stroke risk after elective cardioversion of atrial fibrillation: an analysis of the Flec-SL trial

Stavros Apostolakis1, Karl Georg Haeusler, Michael Oeff

  • 1Centre for Cardiovascular Sciences, School for Clinical and Experimental Medicine, University of Birmingham, and SWBH NHS Trust, Birmingham, UK.

International Journal of Cardiology
|July 23, 2013
PubMed

Insights

Anticoagulation management during cardioversion for atrial fibrillation (AF) is crucial. This study found stroke and bleeding events to be rare, supporting current anticoagulation recommendations for AF cardioversion.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Pharmacology

Background:

  • Current anticoagulation management for cardioversion relies on limited data and expert opinion.
  • Elective cardioversion for atrial fibrillation (AF) requires careful consideration of thrombotic and bleeding risks.

Purpose of the Study:

  • To assess current practices in anticoagulation during and after elective cardioversion for AF.
  • To evaluate the incidence of stroke, transient ischemic attack (TIA), and major bleeding events following cardioversion.

Main Methods:

  • Analysis of 635 patients from the Flec-SL trial (ISRCTN62728743, NCT00215774) undergoing elective cardioversion for AF.
  • Assessment of periprocedural anticoagulation, adequacy of anticoagulation, and cardioversion methods (electrical vs. pharmacological, TEE-guided).
  • Prospective follow-up for stroke, TIA, and major bleeding events.

Main Results:

  • 99.1% of patients received periprocedural anticoagulation; 87.6% were adequately anticoagulated.
  • Stroke/TIA event rate was 0.9% (5 strokes, 3 TIAs), and major bleeding rate was 0.8%.
  • Events were infrequent and not associated with cardioversion type or transesophageal echocardiography (TEE) use.

Conclusions:

  • Stroke and bleeding events are rare in patients undergoing cardioversion for AF with contemporary antithrombotic therapy.
  • Findings support the continued adherence to established anticoagulation guidelines for AF cardioversion.
  • Low event rates suggest current practices are safe and effective in this patient population.
Abstract

Keywords:
AnticoagulationAtrial fibrillationCardioversionMajor bleedingStroke

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