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Safety of cardioversion without anticoagulation in patients' status post left atrial appendage occlusion: A

Khalid Sawalha1, Mohammad Alakchar2, Mamas A Mamas3

  • 1Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts Baystate, Springfield, MA, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|August 28, 2025
PubMed

Insights

Direct current cardioversion (DCCV) after left atrial appendage occlusion (LAAO) is safe without anticoagulation. This study found low risks of stroke and bleeding, supporting its use in selected patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Direct current cardioversion (DCCV) is a standard treatment for atrial fibrillation (AF).
  • Left atrial appendage occlusion (LAAO) is an alternative for stroke prevention in patients unable to take oral anticoagulation (OAC).
  • The safety of DCCV without anticoagulation following LAAO is not well-established.

Purpose of the Study:

  • To assess the safety and efficacy of performing DCCV without systemic anticoagulation in patients who have undergone LAAO.
  • To compare thromboembolic events and bleeding complications between patients with and without post-DCCV anticoagulation.

Main Methods:

  • A systematic review and meta-analysis adhering to PRISMA guidelines.
  • Searched major databases (PubMed, ScienceDirect, Cochrane Library) from January 2010 to April 2025.
  • Included observational studies comparing DCCV outcomes post-LAAO with or without anticoagulation, analyzing thromboembolic and bleeding events.

Main Results:

  • Five studies with 1697 DCCV procedures were analyzed.
  • Thromboembolic events were 3.8% without OAC vs. 1.6% with OAC (OR 0.48, p=0.19).
  • Clinically significant bleeding was similar: 4.1% without OAC vs. 4.0% with OAC (OR 1.22, p=0.42).

Conclusions:

  • DCCV without anticoagulation appears safe in select patients post-LAAO, provided no device-related thrombus or significant leak is present.
  • Low rates of thromboembolic events and bleeding were observed.
  • Further validation through randomized controlled trials is recommended due to limited observational data.
Abstract

Keywords:
AnticoagulationDirect current cardioversion (DCCV)Left atrial appendage occlusion (LAAO)Stroke prevention

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