Transoesophageal echocardiography-guided immediate cardioversion in low-risk patients yielded 75% sinus rhythm maintenance at 1 month versus 45% with conventional warfarin therapy (P<0.01).
Cohort (n=242)
Does TEE-guided immediate cardioversion using specific low-risk criteria prevent thromboembolism and improve sinus rhythm maintenance compared to conventional warfarin therapy in patients with atrial fibrillation or flutter >2 days?
TEE-guided immediate cardioversion using strict low-risk criteria is safe from thromboembolic events and associated with better 1-month sinus rhythm maintenance compared to conventional delayed cardioversion.
Absolute Event Rate: 75% vs 45%
p-value: p=<0.01
AIMS: Despite exclusion of left atrial thrombi by transoesophageal echocardiography, cardioversion-related thromboembolism has been reported in atrial fibrillation or flutter. To define a low-risk group for cardioversion without previous anticoagulation, patients were selected for immediate cardioversion if there were no thrombi, no echo spontaneous contrast and the outflow velocity of the left atrial appendage was greater than 0.25 m. s(-1)on transoesophageal echocardiography. METHODS AND RESULTS: Two hundred and forty-two consecutive patients referred for cardioversion of atrial fibrillation or flutter with a duration of more than 2 days and no anticoagulation therapy were examined with transoesophageal echocardiography. After the transoesophageal echocardiography examination, patients who were eligible for immediate cardioversion were anticoagulated with low molecular weight heparin (dalteparin) subcutaneously, together with warfarin prior to cardioversion. Dalteparin treatment was continued until the patient had reached therapeutic prothrombin values. Based on the transoesophageal echocardiographic findings the patients were divided into two groups: immediate cardioversion, group A, with a mean age of 62+/-13 years (n=162); or conventional warfarin treatment before cardioversion, group B, with a mean age of 67+/-10 years (P or = 25 m. s(-1)) cardioversion can safely be performed in 2/3 of patients with atrial fibrillation or flutter without previous anticoagulation therapy. These patients maintained sinus rhythm significantly better after 1 month compared to patients with prolonged warfarin therapy before cardioversion.
Anders Roijer (Mon,) conducted a cohort in Atrial fibrillation or flutter (n=242). Immediate cardioversion guided by transoesophageal echocardiography vs. Conventional warfarin treatment before cardioversion was evaluated on Maintenance of sinus rhythm at 1 month (p=<0.01). Transoesophageal echocardiography-guided immediate cardioversion in low-risk patients yielded 75% sinus rhythm maintenance at 1 month versus 45% with conventional warfarin therapy (P<0.01).