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Cerebral thromboembolism after direct current cardioversion for pure atrial flutter
L Liaudet1, R Kehtari, J F Enrico
1Department of Internal Medicine, Hôpital des Cadolles, CH-2000 Neuchatel, Switzerland.
Insights
Electrical cardioversion for pure atrial flutter may pose an embolism risk. This case report highlights two cerebral embolisms occurring post-cardioversion, challenging the current standard of care for atrial flutter management.
Area of Science:
- Cardiology
- Electrophysiology
- Neurology
Background:
- Prophylactic anticoagulation is standard before cardioversion for atrial fibrillation due to embolism risk.
- Anticoagulation is not typically used before cardioversion for pure atrial flutter, as it's believed not to increase embolism risk.
Observation:
- A patient developed two cerebral embolisms within 24 hours after undergoing electrical cardioversion for pure atrial flutter.
- This event occurred despite the absence of standard prophylactic anticoagulation.
Findings:
- This case suggests that pure atrial flutter, like atrial fibrillation, may carry a risk of postcardioversion embolism.
- The findings challenge the established clinical practice regarding anticoagulation for atrial flutter cardioversion.
Implications:
- Consideration of prophylactic anticoagulation before electrical cardioversion for pure atrial flutter may be warranted.
- Further research is needed to clarify the actual risk of embolism in patients undergoing cardioversion for pure atrial flutter.
Abstract:
The need for prophylactic anticoagulation before electrical cardioversion for atrial arrhythmias is clearly established in the case of atrial fibrillation. By contrast, such prophylaxis is not a current standard of care before cardioversion for pure atrial flutter, since this arrhythmia seems not to increase the risk of postcardioversion embolism. We present a patient who developed two cerebral embolisms 24 h after electrical cardioversion for pure atrial flutter. To our knowledge, this observation has not been previously reported.