Cardioversion of acute atrial fibrillation without anticoagulation was associated with a 0.7% (95% CI 0.5-1.0%) 30-day incidence of thromboembolic events, with highest risk in heart failure and diabetes.
Cohort (n=2,481)
Yes
The incidence of thromboembolic complications after cardioversion of acute atrial fibrillation without anticoagulation is significant, particularly in patients with heart failure and diabetes, supporting the need for anticoagulation in high-risk subgroups.
OBJECTIVES: This study sought to explore the incidence and risk factors of thromboembolic complications after cardioversion of acute atrial fibrillation. BACKGROUND: Anticoagulation therapy is currently recommended after cardioversion of acute atrial fibrillation in patients with risk factors for stroke, but the implementation of these new consensus-based guidelines has been slow. METHODS: A total of 7,660 cardioversions were performed in 3,143 consecutive patients with atrial fibrillation lasting <48 h in 3 hospitals. For this analysis, embolic complications were evaluated during the 30 days after 5,116 successful cardioversions in 2,481 patients with neither oral anticoagulation nor peri-procedural heparin therapy. RESULTS: There were 38 (0.7%; 95% confidence interval CI: 0.5% to 1.0%) definite thromboembolic events (31 strokes) within 30 days (median 2 days, mean 4.6 days) after cardioversion. In addition, 4 patients suffered transient ischemic attack after cardioversion. Age (odds ratio OR: 1.05; 95% CI: 1.02 to 1.08), female sex (OR: 2.1; 95% CI: 1.1 to 4.0), heart failure (OR: 2.9; 95% CI: 1.1 to 7.2), and diabetes (OR: 2.3; 95% CI: 1.1 to 4.9) were the independent predictors of definite embolic events. Classification tree analysis showed that the highest risk of thromboembolism (9.8%) was observed among patients with heart failure and diabetes, whereas patients with no heart failure and age <60 years had the lowest risk of thromboembolism (0.2%). CONCLUSIONS: The incidence of post-cardioversion thromboembolic complications is high in certain subgroups of patients when no anticoagulation is used after cardioversion of acute atrial fibrillation. (Safety of Cardioversion of Acute Atrial Fibrillation FinCV; NCT01380574).
“Female sex and old age increase the risk of thromboembolic complications after electrical cardioversion of recent onset (< 48 hours) atrial fibrillation especially when delay to cardioversion > 12 hours. Moreover, women with a high risk of stroke were unsatisfactorily treated with oral anticoagulation.”
Airaksinen et al. (Wed,) conducted a cohort in Acute atrial fibrillation (n=2,481). Cardioversion without anticoagulation was evaluated on Definite thromboembolic events within 30 days (95% CI 0.5 to 1.0). Cardioversion of acute atrial fibrillation without anticoagulation was associated with a 0.7% (95% CI 0.5-1.0%) 30-day incidence of thromboembolic events, with highest risk in heart failure and diabetes.
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