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Thromboembolic and bleeding complications after elective cardioversion of atrial fibrillation: a nationwide cohort

Saga Itäinen-Strömberg1, Mika Lehto2,3, Olli Halminen4

  • 1Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland.

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
|June 3, 2024
PubMed

Insights

Elective cardioversion (ECV) for atrial fibrillation (AF) has a low risk of thromboembolic and bleeding complications. Both non-vitamin K oral anticoagulants (NOACs) and warfarin showed similar safety profiles in this study.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Public Health

Background:

  • Elective cardioversion (ECV) is a standard procedure for restoring sinus rhythm in patients with atrial fibrillation (AF).
  • Despite adequate oral anticoagulation, ECV carries a risk of thromboembolic events and bleeding complications.
  • Real-world data on the safety of ECV, comparing different anticoagulation strategies, is crucial for clinical practice.

Purpose of the Study:

  • To evaluate the incidence of thromboembolic and bleeding complications following ECV in a large, real-world atrial fibrillation population.
  • To compare the safety of non-vitamin K oral anticoagulants (NOACs) versus warfarin in patients undergoing ECV.
  • To identify predictors of thromboembolic events after ECV.

Main Methods:

  • Nationwide register-based study of 9625 Finnish AF patients undergoing their first ECV between 2012 and 2018.
  • Analysis of thromboembolic and bleeding complications within 30 days post-ECV.
  • Comparison of complication rates between patients treated with warfarin and NOACs.

Main Results:

  • A total of 0.5% thromboembolic complications and 0.3% bleeding events were observed.
  • Thromboembolic event rates were similar between NOAC (0.4%) and warfarin (0.6%) users (OR 0.77; 95% CI 0.42-1.39).
  • Higher international normalized ratio (INR) ≥2.5 in warfarin users was associated with a lower risk of thromboembolic complications (0.4% vs 0.9%). Age and alcohol abuse were significant predictors.

Conclusions:

  • The rate of thromboembolic and bleeding complications associated with ECV is low.
  • No significant difference in complication rates was found between NOAC and warfarin treatment groups.
  • Maintaining an INR ≥2.5 during warfarin therapy for ECV may reduce the risk of thromboembolic events.
Abstract

Keywords:
Atrial fibrillationComplicationsElective cardioversionOral anticoagulation

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