Author + information
- Received July 20, 2015
- Revision received December 28, 2015
- Accepted January 28, 2016
- Published online August 1, 2016.
- Aatish Garg, MDa,
- Monica Khunger, MDa,
- Sinziana Seicean, MD, MPH, PhDb,
- Mina K. Chung, MDb and
- Patrick J. Tchou, MDb,∗ ()
- aDepartment of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Reprint requests and correspondence:
Dr. Patrick J. Tchou, Department of Cardiovascular Medicine, Section of EP & Pacing, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Objectives This study sought to compare the risk of thromboembolism after cardioversion within 48 h of atrial fibrillation (AF) onset in patients therapeutically versus not therapeutically anticoagulated.
Background Although guidelines do not mandate anticoagulation for cardioversion within 48 h of AF onset, risk of thromboembolism in this group has been understudied.
Methods Patients undergoing cardioversion within 48 h after AF onset were identified from a prospectively collected database and retrospectively reviewed to determine anticoagulation status and major thromboembolic events within 30 days of cardioversion.
Results Among 567 cardioversions in 484 patients without therapeutic anticoagulation (mean CHA2DS2-VASc score, 2.3 ± 1.7), 6 had neurological events (1.06%), all in patients on aspirin alone. Among 898 cardioversions in 709 patients on therapeutic anticoagulation (mean CHA2DS2-VASc score, 2.6 ± 1.7; p = 0.017), 2 neurological events occurred (0.22%; OR: 4.8; p = 0.03), both off anticoagulation at the time of stroke. No thromboembolic events occurred in patients with CHA2DS2-VASc score <2 (p = 0.06) or in patients with postoperative AF.
Conclusions In patients with acute-onset AF, odds of thromboembolic complications were almost 5 times higher in patients without therapeutic anticoagulation at the time of cardioversion. However, no events occurred in post-operative patients and in those with CHA2DS2-VASc scores of <2, supporting the utility of accurate assessment of AF onset and risk stratification in determining the need for anticoagulation for cardioversion of AF <48 h in duration.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 20, 2015.
- Revision received December 28, 2015.
- Accepted January 28, 2016.
- American College of Cardiology Foundation