Embolic Risk Is Time-dependent

Cardioversion in Non-valvular Atrial Fibrillation by Prof. Dr. med. Hermann H. Klein and Prof. Dr. med. Hans-Joachim Trappe in issue 50/2015

The nice review by Klein und Trappe (1) should be supplemented by the data of Nuotio et al. (2). In a retrospective analysis of 5116 cardioversions without prior anticoagulation, thromboembolic events occurred only in 0.3% of patients when cardioversion was performed within the first 12 hours of atrial fibrillation. However, this rate increased to 1.1% when cardioversion was performed after more than 12 but less than 48 hours.

The rate of thromboembolic events in the entire patient population was 0.7%, thus within the range of 0.3% to 0.8% reported elsewhere (3).

In my view, the almost fourfold increase in risk of thromboembolic events observed when cardioversion is performed more than 12 hours after onset of atrial fibrillation indicates that it might be useful to review the practice of cardioversion without prior transesophageal echocardiography even after an atrial fibrillation duration of less than 48 hours and to initiate adequate oral anticoagulation therapy in all non-urgent cases with atrial fibrillation of more than 12 hours' duration.

DOI: 10.3238/arztebl.2016.0422a

Dr. med. Michael Kuklinski
Facharztzentrum am Stadtgarten, Aalen, Germany

References

1. Klein HH, Trappe HJ: Cardioversion in non-valvular atrial fibrillation. Dtsch Arztebl Int 2015; 112: 856–62

2. Nuotio I, Hartikainen JK, Grönberg T, Biancari F, Airaksinen K: Time to cardioversion for acute atrial fibrillation and thromboembolic complications. JAMA 2014; 312: 647–9

3. Fuster V, Rydén LE, Cannom DS, et al.: ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. Circulation 2006; 114: e257–354