Key result
Anticoagulation for 3 to 4 weeks before cardioversion prevents thromboembolic events in AF.
Why the study?
To review the epidemiology and risk factors for left atrial appendage thrombosis, the role of echocardiography before cardioversion, and the efficacy of different anticoagulant regimens.
This review discusses the epidemiology, risk factors, and management of left atrial appendage thrombosis in atrial fibrillation patients undergoing cardioversion, emphasizing the roles of transesophageal echocardiography and anticoagulation.
Answers are grounded in this paper and cite their sources.
Supports pre-cardioversion anticoagulation in AF; extends evidence synthesis but leaves open optimal individualized strategies.
Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of stroke and thromboembolic complications. A rhythm control strategy with both electrical and pharmacological cardioversion is recommended for patients with symptomatic atrial fibrillation. Anticoagulant therapy for 3–4 weeks prior to cardioversion is recommended in order to avoid thromboembolic events deriving from restoring sinus rhythm. Transesophageal echocardiography has a pivotal role in this setting, excluding the presence of left atrial appendage thrombus before cardioversion. The aim of this review is to discuss the epidemiology and risk factors for left atrial appendage thrombosis, the role of echocardiography in the decision making before cardioversion, and the efficacy of different anticoagulant regimens on the detection and treatment of left atrial appendage thrombosis.
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Melillo et al. (2019) studied this question. Anticoagulant therapy for 3–4 weeks prior to cardioversion is essential to prevent thromboembolic events in atrial fibrillation patients.
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