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Electrical cardioversion in patients with left ventricular thrombus: A systematic review of safety and thromboembolic

Carlson Sama1, Muchi Ditah Chobufo2, Ademola Ajibade3

  • 1Department of Cardiology, Heart and Vascular Institute, West Virginia University Hospital, Morgantown, WV, USA.

JRSM Cardiovascular Disease
|April 28, 2026
PubMed

Insights

Electrical cardioversion for left-ventricular (LV) thrombus appears safe, with no observed thromboembolic events in a systematic review. Individualized, imaging-guided decisions with anticoagulation are recommended.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Thrombosis Research

Background:

  • The thromboembolic risk associated with electrical cardioversion in patients with left-ventricular (LV) thrombus remains unclear, leading to inconsistent clinical practices.
  • This systematic review aims to consolidate reported thromboembolic outcomes following cardioversion in individuals with imaging-confirmed LV thrombus.

Purpose of the Study:

  • To systematically review and synthesize data on thromboembolic outcomes after electrical cardioversion in patients diagnosed with left-ventricular thrombus.
  • To provide evidence-based insights for clinical decision-making regarding cardioversion in this patient population.

Main Methods:

  • A systematic literature search was conducted on PubMed and Scopus up to July 25, 2025.
  • Studies reporting outcomes after direct-current or internal electrical cardioversion in patients with known LV thrombus were included; case reports and pharmacological cardioversion studies were excluded.
  • The primary endpoint was the occurrence of clinically apparent thromboembolic complications, with data synthesized narratively.

Main Results:

  • Three retrospective studies involving 68 patients with imaging-proven LV thrombus met the inclusion criteria.
  • While most thrombi were fixed, approximately 8% were mobile in one study. Anticoagulation varied, with 21% receiving none prior to cardioversion.
  • No thromboembolic events directly linked to electrical cardioversion were observed across a follow-up period ranging from 3 months to 1 year.

Conclusions:

  • Limited evidence suggests that electrical cardioversion may not lead to clinically overt thromboembolic events in patients with known LV thrombus.
  • Clinical decisions should be individualized, guided by imaging, optimized anticoagulation, and multidisciplinary consultation.
  • Further research is warranted to definitively establish the safety profile and optimize management strategies.
Abstract

Keywords:
Left ventricular thrombuscomplicationsefficacyelectrical cardioversionstrokethromboembolism

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