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Research Article| Volume 168, ISSUE 4, P3977-3981, October 09, 2013

Low stroke risk after elective cardioversion of atrial fibrillation: An analysis of the Flec-SL trial

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Stavros Apostolakis
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Centre for Cardiovascular Sciences, School for Clinical and Experimental Medicine, University of Birmingham, and SWBH NHS Trust, Birmingham, UK
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Karl Georg Haeusler
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Neurology, Charité — Universitätsmedizin Berlin & Center for Stroke Research, Berlin, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Michael Oeff
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, Hospital Brandenburg, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Andras Treszl
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Medical Biometry and Epidemiology, University of Hamburg, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Dietrich Andresen
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, Vivantes Urban Hospital, Berlin, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Martin Borggrefe
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, University of Mannheim, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Gregory Y.H. Lip
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Centre for Cardiovascular Sciences, School for Clinical and Experimental Medicine, University of Birmingham, and SWBH NHS Trust, Birmingham, UK
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Thomas Meinertz
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    University Heart Center, University of Hamburg, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Ulrich Parade
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Klinikum Ludwigsburg, Ludwigsburg, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Alexander Samol
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiovascular Medicine, Hospital of the University of Münster, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Gerhard Steinbeck
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, Ludwig-Maximilians-University of Munich, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Karl Wegscheider
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Medical Biometry and Epidemiology, University of Hamburg, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Günter Breithardt
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiovascular Medicine, Hospital of the University of Münster, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Paulus Kirchhof
    Correspondence
    Corresponding author at: University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, Institute of Biomedical Research IBR 139, Birmingham B15 2TT, England, UK.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Centre for Cardiovascular Sciences, School for Clinical and Experimental Medicine, University of Birmingham, and SWBH NHS Trust, Birmingham, UK

    Department of Cardiovascular Medicine, Hospital of the University of Münster, Germany

    German Atrial Fibrillation Competence Network (AFNET), Germany
    Search for articles by this author
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

      Abstract

      Background

      Current recommendations for anticoagulation management during cardioversion are largely based on historical data and expert consensus.

      Methods and results

      To characterize current practice of anticoagulation during and after elective cardioversion for AF and the risk of stroke and bleeding events, all patients enrolled into the Flec-SL trial were analyzed for stroke/transient ischemic attack and major bleeds after cardioversion.
      Flec-SL (ISRCTN62728743, NCT00215774) enrolled 635 patients (mean age 63.7 ± 10.9, 66% male). 629 (99.1%) patients received periprocedural anticoagulation, 556 (87.6%) were adequately anticoagulated following current recommendations. 202 (31.8%) patients underwent transesophageal echocardiography-guided cardioversion. Electrical cardioversion was used in 508 patients (80.0%), pharmacological cardioversion in 127 (20%). Six patients suffered from stroke (n = 5) or transient ischemic attack (3 TIAs in 1 patient, event rate 0.9%, 95% CI 0.4–2.1), five others from major bleeds (event rate 0.8%, 95% CI 0.3–1.9), consistent with the low reported event rates in prior studies. Three strokes occurred in the first 5 days after cardioversion. Events were independent of type of cardioversion or the use of TEE to exclude thrombi.

      Conclusion

      Strokes are rare in this large, prospectively followed cohort of patients undergoing cardioversion for AF and receiving antithrombotic therapy following local routine. These results support adherence to current recommendations for anticoagulation during cardioversion of AF.

      Keywords

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