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Published on: February 28, 2012
Back to sinus rhythm from atrial flutter or fibrillation: dabigatran is safe without transoesophageal control
Dragos Cozma, Caius Glad Streian1, Cristina Vacarescu
1Universitatea de Medicina si Farmacie "Victor Babes" Timisoara, Romania. cstreian@cardiologie.ro.
Insights
Dabigatran effectively converted persistent atrial fibrillation and flutter to sinus rhythm without transoesophageal echocardiography. This study found no major cardiac events, suggesting a safe alternative for cardioversion.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Persistent atrial fibrillation (PAF) and atrial flutter (AFL) are common arrhythmias.
- Cardioversion aims to restore normal sinus rhythm (SR).
- Transoesophageal echocardiography (TEE) is often used to rule out left atrial thrombi before cardioversion.
Purpose of the Study:
- To evaluate the safety and efficacy of dabigatran for cardioversion of PAF and AFL to SR.
- To determine if TEE is necessary when using dabigatran for cardioversion.
Main Methods:
- 82 patients with PAF or AFL received dabigatran for three weeks prior to and six months after cardioversion.
- Left atrium area (LAA) and left atrium volume (LAV) were measured.
- Patients were followed for major cardiac events at 1, 3, 6, and 12 months post-procedure.
Main Results:
- 49 patients underwent successful electric cardioversion, 11 had pharmacological conversion, and 22 underwent radiofrequency ablation.
- The mean CHA2DS2-VASc score was high (2.96 ± 1.39), with 58.6% scoring over 3.
- No major cardiac events were reported during the follow-up period of approximately 19.4 months.
Conclusions:
- Dabigatran facilitated safe cardioversion of PAF and AFL to SR.
- TEE was not required in this cohort, indicating a potential simplification of the cardioversion procedure.
Background And Aim:
To assess the safety of dabigatran in converting persistent atrial fibrillation (PAF) and atrial flutter (AFL) to sinus rhythm (SR) without transoesophageal echocardiography (TEE) evaluation.
Methods:
Consecutive patients with PAF or AFL were included between 2012 and 2015. Dabigatran was used for three weeks before and six months after cardioversion. Left atrium area (LAA) and left atrium volume (LAV) were assessed in all patients. Follow-up visits for major cardiac events occurred at 1, 3, 6, and 12 months.
Results:
The study included 82 patients (56 male, mean age 63.1 ± 10.4 years), of which 45 had PAF and 37 AFL. In patients with PAF, mean LAA was 30.3 ± 5.3 cm2 and LAV 114.4 ± 31.5 mL; in those with AFL mean LAA was 26.5 ± 4.2 cm2 and LAV 97 ± 24.9 mL at baseline. Forty-nine patients underwent uncomplicated electric cardioversion (38 with PAF and 11 with AFL), 11 patients were pharmacologically converted to SR (7 with PAF and 4 with AFL), and 22 patients with AFL underwent successful radiofrequency ablation. The mean CHA2DS2-VASc score was 2.96 ± 1.39 (score > 3, 58.6%). No major cardiac events occurred during the follow-up period of 19.4 ± 9.5 months.
Conclusions:
Safe cardioversion using dabigatran was achieved in this small group of patients without the need for TEE.
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