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Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation
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Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

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Clinical outcomes after AF cardioversion in patients presenting left atrial sludge in trans-esophageal

Fabien Squara1, Mikael Bres2, Didier Scarlatti2

  • 1Hôpital Pasteur, Service de Cardiologie, 30 avenue de la Voie Romaine, CS 51069 06001, Nice Cedex 1, France. fabiensquara@gmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|May 24, 2019
PubMed

Insights

Direct-current cardioversion (DCC) for atrial fibrillation is safe even with atrial sludge if no left atrial appendage thrombus is present. This finding supports current guidelines, advising against cardioversion only when atrial thrombus is confirmed.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Direct-current cardioversion (DCC) for atrial fibrillation (AF) carries a stroke risk, potentially due to post-cardioversion atrial stunning.
  • Cardiac thrombus, typically in the left atrial appendage (LAA), is a contraindication for DCC.
  • Atrial sludge without LAA thrombus is often considered a relative contraindication, prompting further investigation.

Purpose of the Study:

  • To evaluate the safety of DCC in patients with atrial fibrillation who exhibit atrial sludge but no LAA thrombus.

Main Methods:

  • Prospective inclusion of consecutive patients with atrial sludge (no LAA thrombus) undergoing DCC for persistent AF.
  • Safety assessment focused on clinical events within 1 month post-cardioversion, covering the atrial stunning period.
  • Clinical examination and the Questionnaire for Verifying Stroke-Free Status (QVSFS) were used for evaluation.

Main Results:

  • Twenty-one patients with atrial sludge but no LAA thrombus underwent DCC over 2 years.
  • No clinical embolic or cardiac events, or unscheduled hospitalizations occurred within the 1-month follow-up.
  • Sixty-seven percent of patients maintained sinus rhythm at the 1-month follow-up.

Conclusions:

  • Direct-current cardioversion for atrial fibrillation is safe in patients with atrial sludge but without left atrial appendage thrombus.
  • Findings support current guidelines classifying only atrial thrombus as a contraindication for cardioversion.
  • Larger studies are recommended to further validate these results.
Abstract

Keywords:
Atrial fibrillationCardioversionSludge

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