Thromboembolic complications after cardioversion of acute atrial fibrillation - The FinCV study.
J Am Coll Cardiol. 2013 Jun 27;
Authors: Airaksinen KE, Grönberg T, Nuotio I, Nikkinen M, Ylitalo A, Biancari F, Hartikainen JE
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 7660 cardioversions were performed in 3143 consecutive patients with atrial fibrillation lasting < 48 hours in three hospitals. For this analysis, embolic complications were evaluated during the 30 days after 5116 successful cardioversions in 2481 patients with neither oral anticoagulation nor periprocedural heparin therapy.
RESULTS: There were 38 (0.7%; 95%CI 0.5-1.0%) 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 (OR 1.05; 95%CI 1.02-1.08), female gender (OR 2.1; 95%CI 1.1-4.0), heart failure (OR 2.9; 95%CI 1.1-7.2) and diabetes (OR 2.3; 95%CI 1.1-4.9) 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 postcardioversion thromboembolic complications is high in certain subgroups of patients when no anticoagulation is used after cardioversion of acute atrial fibrillation.
PMID: 23850908 [PubMed - as supplied by publisher]