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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Article info
Publication history
Published online: July 22, 2013
Accepted:
June 30,
2013
Received in revised form:
May 27,
2013
Received:
March 18,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
