Efficacy and Transesophageal Echocardiographic Findings of Short-term Dabigatran or Rivaroxaban Therapy for Electrical Cardioversion in Patients with Atrial Fibrillation

Background and Objectives: The efficacy of short-term novel oral anticoagulant (NOAC) therapy for electrical cardioversion has not been fully evaluated. This study sought to investigate the efficacy and transesophageal echocardiographic (TEE) findings of short-term dabigatran or rivaroxaban therapy versus warfarin therapy in patients undergoing electrical cardioversion for atrial fibrillation. Subject and Methods: This registry study included patients with persistent atrial fibrillation who underwent elective electrical cardioversion. We analyzed 115 patients (42 in dabigatran, 33 in rivaroxaban, and 40 in warfarin group) who were taking oral anticoagulants for maximum of 42 days. All patients underwent TEE before electrical cardioversion. The primary outcome was stroke or systemic embolism at 30 days. Another outcome was major bleeding. Results: Baseline characteristics were similar between patients in the NOAC and warfarin groups. The mean CHA2DS2-VASc score was 1.2±1.5 in the dabigatran group, 0.7±1.2 in the rivaroxaban group, and 1.1±1.3 in the warfarin group (p=0.918, dabigatran vs. warfarin; p=0.078, rivaroxaban vs. warfarin). None of the patients in this study had thrombi. There was no difference in the incidence of left atrial spontaneous echo contrast between groups (28.6%, 21.2%, and 22.5% in dabigatran, rivaroxaban, and warfarin groups, respectively; p=0.529, dabigatran vs. warfarin; p=0.895, rivaroxaban vs. warfarin). No strokes or systemic embolisms were observed during the 30-day follow-up period. There were no major bleeding events. Conclusion: The short-term use of dabigatran or rivaroxaban can be considered safe in patients undergoing electrical cardioversion for atrial fibrillation.