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TEE-geführte Kardioversion bei Patienten mit Vorhofflimmern ohne vorherige Antikoagulation

TEE-guided cardioversion in patients with atrial fibrillation without previous anticoagulation

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Summary

A total of 332 patients (mean age 65±10 years, 86 female) with nonvalvular atrial fibrillation (AF) of more than 48 hours duration and lack of a sufficient anticoagulation were included. After exclusion of thrombotic material in the left atrium using transesophageal echocardiography (TEE) cardioversion (CV) was performed within 24 hours. At the same time oral anticoagulation (AC) (overlapping with PTT-affecting heparinisation) was started. If thrombi were found by TEE, the examination was repeated after at least four weeks of anticoagulation. If thrombi were absent at this time, CV was performed. Periprocedural embolism was defined as primary endpoint, whereas the detection of atrial thrombi before CV was defined as secondary endpoint.

In 33 of the 332 Patients (9.9%) the TEE showed a thrombus in the left atrium respectively the left atrial appendage (n=22) or thrombi could not be excluded (n=11). 383 TEEs were performed without complications in an overall of 332 patients.

A total of 305 CV were performed (electrical n=300, pharmacological n=5) and during periprocedural monitoring and in the time of four weeks after CV no thromboembolic complications were observed.

TEE-guided CV in patients with AF persisting for more than 48 hours and without previous AC can be considered as a method that is both safe and effective.

Zusammenfassung

In einer retrospektiven Studie wurden 332 Patienten (65±10 Jahre, 86 Frauen) mit seit mehr als 48 Stunden bestehendem nichtrheumatischem Vorhofflimmern (VHF) und dem Fehlen einer vorangegangenen suffizienten Antikoagulation eingeschlossen. Nach Ausschluss von Vorhofthromben mittels transösophagealer Echokardiographie (TEE) erfolgte unter Initiierung einer Antikoagulation mit Marcumar (überlappend mit PTT-wirksamer Heparinisierung) innerhalb von 24 Stunden eine Kardioversion (CV). Bei Vorhofthrombennachweis wurde nach mindestens vierwöchiger Antikoagulation eine erneute TEE durchgeführt. Wenn dabei keine Thromben mehr nachweisbar waren, erfolgte die CV.

Als primärer Endpunkt wurde eine periprozedurale Embolie und als sekundärer Endpunkt wurde ein nachgewiesener Vorhofthrombus vor Kardioversion definiert.

Bei 33 der 332 Patienten (9,9%) konnten in der TEE Thromben im Bereich des linken Vorhofes bzw. linken Vorhofohres nachgewiesen (n=22) oder nicht sicher ausgeschlossen (n=11) werden. Es wurden 383 TEE bei insgesamt 332 Patienten komplikationsfrei durchgeführt.

Insgesamt wurden 305 CV durchgeführt (elektrisch n=300, pharmakologisch n=5). Bei Durchführung der CV- und im Zeitraum von vier Wochen nach CV-ereigneten sich keine thrombembolischen Komplikationen.

Die TEE-geführte Kardioversion bei Patienten mit länger als 48 Stunden bestehendem Vorhofflimmern ohne vorherige Antikoagulation ist als ein sicheres und effizientes Verfahren anzusehen.

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Authors and Affiliations

  1. Städtisches Klinikum München—Bogenhausen I. Medizinische Abteilung, Englschalkinger Str. 77, 81925, München, Germany

    P. Halbfaß

  2. Deutsches Herzzentrum & 1. Medizinische Klinik, Klinikum rechts der Isar, München, Germany

    P. Halbfaß, A. Plewan, K. Dennig, C. Kolb & C. Schmitt

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Halbfaß, P., Plewan, A., Dennig, K. et al. TEE-geführte Kardioversion bei Patienten mit Vorhofflimmern ohne vorherige Antikoagulation. Herzschr. Elektrophys. 17, 127–132 (2006). https://doi.org/10.1007/s00399-006-0523-z

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