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Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without

Morten Lock Hansen1, Rikke Malene H G Jepsen2, Jonas Bjerring Olesen3

  • 1Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark mortenlh@yahoo.com.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|September 19, 2014
PubMed

Insights

Direct current cardioversion for atrial fibrillation significantly increases thromboembolism risk without oral anticoagulation. Patients undergoing this procedure require careful monitoring, especially in the initial post-cardioversion period.

Area of Science:

  • Cardiology
  • Thrombosis Research
  • Public Health

Background:

  • Atrial fibrillation is a common arrhythmia associated with increased risk of thromboembolic events.
  • Direct current cardioversion is a procedure used to restore normal heart rhythm in patients with atrial fibrillation.
  • The role of oral anticoagulant therapy in mitigating thromboembolism risk during and after direct current cardioversion requires further investigation.

Purpose of the Study:

  • To investigate the risk of thromboembolism in patients with atrial fibrillation undergoing direct current cardioversion.
  • To compare the thromboembolic risk between patients who received oral anticoagulant therapy and those who did not.
  • To assess the impact of anticoagulant coverage on the safety of direct current cardioversion.

Main Methods:

  • Retrospective cohort study of 16,274 patients in Denmark undergoing first-time direct current cardioversion for atrial fibrillation (2000-2008).
  • Data on oral anticoagulant use was obtained from the Danish Register of Medicinal Product Statistics.
  • Thromboembolic risk was analyzed using incidence rates and multivariable adjusted Cox proportional-hazard models.

Main Results:

  • Patients without prior oral anticoagulant therapy had a significantly higher incidence rate of thromboembolism (10.33 per 100 patient-years) compared to those with prior therapy (4.00 per 100 patient-years).
  • The hazard ratio for thromboembolism in patients without prior oral anticoagulation was 2.25 (95% CI, 1.43-3.53).
  • Thromboembolic risk stratification using CHADS2 and CHA2DS2-VASc scores did not alter these findings.

Conclusions:

  • Direct current cardioversion for atrial fibrillation without oral anticoagulation is linked to a high risk of thromboembolism.
  • The heightened risk is particularly evident in the initial period following cardioversion.
  • Anticoagulant coverage is crucial for reducing thromboembolic complications associated with direct current cardioversion in atrial fibrillation patients.
Abstract

Keywords:
Atrial fibrillationDirect current cardioversionOral anticoagulationThromboembolism

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