Advertisement

Atrial Fibrillation and Thromboembolic Risk: Is It Safe to Cardiovert Acutely under Heparin?

  • M. Disertori
  • A. Menotti

Abstract

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and predisposes a person to significant increase of systemic embolism. The risk of systemic embolism, particularly cerebral embolism, is present when arrhythmia is chronic but is higher at the moment of cardioversion to sinus rhythm (SR), when the resumption of mechanical activity of atrium and left atrium appendage (LAA) can favor embolisation of thrombus.

Keywords

Atrial Fibrillation Anticoagulant Therapy Atrial Flutter Electrical Cardioversion Thromboembolic Risk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kinch JW, Davidoff R (1995) Prevention of embolic events after cardioversion of atrial fibrillation. Current and evolving strategies. Arch Intern Med 155: 1353–1360Google Scholar
  2. 2.
    Bjerkelund CJ, Orning OM (1969) The efficacy of anticoagulant therapy in preventing embolism related to DC electrical cardioversion of atrial fibrillation. Am J Cardiol 23: 208–214PubMedCrossRefGoogle Scholar
  3. 3.
    Weinberg DM, Mancini GBJ (1989) Anticoagulation for cardioversion of atrial fibrillation. Am J Cardiol 63: 745–746PubMedCrossRefGoogle Scholar
  4. 4.
    Arnold AZ, Mick MJ, Mazurek RP et al (1992) Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol 19: 851–855PubMedCrossRefGoogle Scholar
  5. 5.
    Laupacis A, Albers G, Dunn M et al (1992) Antithrombotic therapy in atrial fibrillation. Chest 102 (suppl): 426S - 433SPubMedCrossRefGoogle Scholar
  6. 6.
    Stoddard MF, Dawkins PR, Prince CR, Ammash NM (1995) Left atrial thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study: J Am Coll Cardiol 25: 452–459Google Scholar
  7. 7.
    Collins LJ, Silverman DI, Douglas PS, Manning WJ (1995) Cardioversion of nonrheumatic atrial fibrillation. Reduced thromboembolic complications with 4 weeks of precardioversion anticoagulation are related to atrial thrombus resolution. Circulation 92: 156–159CrossRefGoogle Scholar
  8. 8.
    Black IW, Fatkin D, Sagar KB et al (1994) Exclusion of atrial thrombus by trans-esophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. A multicenter study. Circulation 89: 2509–2513Google Scholar
  9. 9.
    Fatkin D, Kuchar DL, Thorburn CW, Feneley MP (1994) Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for “atrial stunning” as a mechanism of thromboembolic complications. J Am Coll Cardiol 23: 307–316PubMedCrossRefGoogle Scholar
  10. 10.
    Grimm RA, Stewart WJ, Maloney JD et al (1993) Impact of electrical cardioversion of atrial fibrillation on left atrial appendage function and smoke: characterization by simultaneous transesophageal echocardiography. J Am Coll Cardiol 22: 1359–1366PubMedCrossRefGoogle Scholar
  11. 11.
    Mugge A, Kuhne H, Daniel WG (1993) The role of transesophageal echocardiography in the detection of left atrial thrombi. Echocardiography 10: 405–417PubMedCrossRefGoogle Scholar
  12. 12.
    Fatkin D, Kelly RP, Feneley MP (1994) Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol 23: 961–969PubMedCrossRefGoogle Scholar
  13. 13.
    Daniel WG, Nellessen U, Schroder E, et al (1988) Left atrial spontaneous echo contrast in mitral valve disease: an indicator for an increase thromboembolic risk. J Am Coll Cardiol 11: 1204–1211PubMedCrossRefGoogle Scholar
  14. 14.
    Leung DY, Black IW, Cranney GB et al (1994) Prognostic implication of left atrial spontaneous echo contrast in non valvular atrial fibrillation. J Am Coll Cardiol 24: 755–762PubMedCrossRefGoogle Scholar
  15. 15.
    Manning WJ, Silverman DI, Waksmonsky CA (1995) Prevalence of residual left atrial thrombi among patients with acute thromboembolism and newly recognized atrial fibrillation. Arch Intern Med 155: 2193–2197PubMedCrossRefGoogle Scholar
  16. 16.
    Black IW,Chesterman CN, Hopkins AP et al (1994) Hematologic correlates of left atrial spontaneous contrast and thromboembolism in non valvular atrial fibrillation. J Am Coll Cardiol 73: 672–676CrossRefGoogle Scholar
  17. 17.
    Mugge A, Kuhn H, Nikutta P, Grote J, Lopez JAG, Daniel WG (1994) Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk. J Am Coll Cardiol 23: 599–607PubMedCrossRefGoogle Scholar
  18. 18.
    Rubin DN, Katz SE, Riley MF, Douglas PS, Manning WJ (1996) Evaluation of left atrial appendage anatomy and function in recent-onset atrial fibrillation by trans-esophageal echocardiography. Am J Cardiol 78: 774–778PubMedCrossRefGoogle Scholar
  19. 19.
    Mitusch R, Garbe M, Schmucker G, Schwabe K, Stierle U, Sheukhzadeh A (1995) Relation of left atrial appendage function to the duration and reversibility of nonvalvular atrial fibrillation. Am J Cardiol 75: 944–947PubMedCrossRefGoogle Scholar
  20. 20.
    Tanabe K, Nakayama K, Ishibashi Yet al (1993) Prediction of outcome after electrical cardioversion by left atrial appendage flow velocity in atrial fibrilation. Circulation 88 (suppl): I - 313CrossRefGoogle Scholar
  21. 21.
    Labinaz M, Chan KL, Tang ASL (1993) Transesophageal doppler parameters and atrial electrogram during atrial fibrillation/flutter: prediction of recurrence after cardioversion: Circulation 88 (suppl): I - 314Google Scholar
  22. 22.
    Verhorst PMJ, Welling RC, Kemp O, Visser CA (1995) Transesophageal echocardiographic and clinical predictors for outcome of cardioversion of atrial fibrillation. J Am Coll Cardiol 25 (suppl): P954CrossRefGoogle Scholar
  23. 23.
    Grimm RA, Stewart WJ, Maloney JD et al (1993) Impact of electrical cardioversion of atrial fibrillation on left atrial appendage function and smoke: characterization by simultaneous transesophageal echocardiography. J Am Coll Cardiol 22: 1359–1366PubMedCrossRefGoogle Scholar
  24. 24.
    Manning WJ, Silverman DI, Katz SE et al (1994) Impaired left atrial mechanical function after cardioversion: relationship to the duration of atrial fibrillation. J Am Coll Cardiol 23: 1535–1540PubMedCrossRefGoogle Scholar
  25. 25.
    Manning WJ, Leeman DE, Gotch PJ, Come PC (1989) Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation. J Am Coll Cardiol 13: 745–746CrossRefGoogle Scholar
  26. 26.
    Manning WJ, Silverman DI, Katz SE et al (1995) Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm. Am J Cardiol 75: 624–626PubMedCrossRefGoogle Scholar
  27. 27.
    Falcone RA, Morady F, Armstrong WF (1996) Transesophageal echocardiographic evaluation of left atrial appendage function and spontaneous contrast formation after chemical or electrical cardioversion of atrial fibrillation. Am J Cardiol 78: 435–439PubMedCrossRefGoogle Scholar
  28. 28.
    Fatkin D, Scalia G, Jacobs N et al (1996) Accuracy of biplane transesophageal echocardiography in detecting left atrial thrombus. Am J Cardiol 77: 321–323PubMedCrossRefGoogle Scholar
  29. 29.
    Hwang JJ, Chen JJ, Lin SC et al (1993) Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations. Am J Cardiol 72: 677–681PubMedCrossRefGoogle Scholar
  30. 30.
    Manning WJ, Weintraub RM, Waksmonski CA, Haering MJ et al (1995) Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med 123: 817–822Google Scholar
  31. 31.
    Grimm RA, Klein AL, Cohen GI, Maloney JD (1992) Transesophageal echocardiography in patients with atrial arrhythmias undergoing electrical cardioversion: identification of sources of emboli. PACE 15: 587 (abstr)Google Scholar
  32. 32.
    Chan M, Marcus R, Bednarz L, Childers R, Lang R (1992) Contribution of trans-esophageal echocardiography to cardioversion protocols for atrial fibrillation. J Am Soc Echocardiogr 5: 308 (abstr)Google Scholar
  33. 33.
    Daniel WG, Freedberg RS, Grote J et al (1992) Incidence of left atrial thrombi in patients with non valvular atrial fibrillation - A multicenter study using trans-esophageal echocardiography. Circulation 86 (suppl): I - 396CrossRefGoogle Scholar
  34. 34.
    Orsinelli DA, Pearson AC (1993) Usefulness of transesophageal echocardiography to screen for left atrial thrombus before elective cardioversion for atrial fibrillation. Am J Cardiol 72: 1337–1339PubMedCrossRefGoogle Scholar
  35. 35.
    Black IW, Grimm RA, Walsh WF et al (1993) Risk factors for atrial thrombus and stroke in 156 patients undergoing electrical cardioversion: a multicenter trans-esophageal echocardiographic study. J Am Coll Cardiol (special issue): 28AGoogle Scholar
  36. 36.
    Antonielli E, Pizzuti A, Gandolfo N et al (1995) L’ecocardiografia transesofagea nei pazienti in fibrillazione atriale candidati a cardioversione: utilità e limiti. G Ital Cardiol 25: 543–552PubMedGoogle Scholar
  37. 37.
    Stoddard MF, Dawkins PR, Prince CR, Longaker RA (1995) Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation. Am Heart J 129: 1204–1215PubMedCrossRefGoogle Scholar
  38. 38.
    Klein AL, Grimm RA, Black IW, Stoddard MF et al for the ACUTE Investigators (1994) Assessment of cardioversion using transesophageal echocardiography compared to conventional therapy: the ACUTE randomized pilot study. Circulation 90(suppl):I21Google Scholar
  39. 39.
    Manning WJ, Silverman DI, Keighley CS, Oettgen P, Douglas PS (1995) Transesophageal echocardiography-facilitated early cardioversion from atrial fibrillation utilizing short-term anticoagulation: final results of a prospective 4.5-years study. J Am Coll Cardiol 25: 1354–1361PubMedCrossRefGoogle Scholar
  40. 40.
    Menotti A, Imperadore F, Disertori M (1997) L’ecocardiografia transesofagea può ridurre it rischio embolico nella cardioversione della fibrillazione atriale? In: Disertori M, Marconi P (eds) Atti del Congresso Firenze Aritmie ‘87, pp 303–317Google Scholar
  41. 41.
    Klein AL, Grimm RA, Black IW et al. for the ACUTE Investigators (1994) Cost-effectiveness of TEE-guided cardioversion with anticoagulation compared to conventional therapy in patients with atrial fibrillation. J Am Coll Cardiol (special issue):128AGoogle Scholar
  42. 42.
    Seto TB, Taira DA, Warren JT, Manning WJ (1995) Cost-effectiveness of early cardioversion guided by transesophageal echocardiography for hospitalized patients with atrial fibrillation. J Am Coll Cardiol (special issue): 202Google Scholar
  43. 43.
    Mehta D, Baruch L (1996) Thromboembolism following cardioversion of “common” atrial flutter. Chest 110: 1001–1003PubMedCrossRefGoogle Scholar
  44. 44.
    Baruch L, Chockalngam S, Shields V, Mehta D, Stern E, Calvin E (1995) Cardioversion of atrial flutter: atrial appendage stunning and thromboembolic potential. A trans-esophageal echocardiographic study. J Am Coll Cardiol (special issue): 203Google Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • M. Disertori
    • 1
  • A. Menotti
    • 2
  1. 1.Reparto di CardiologiaOspedale Santa ChiaraTrentoItaly
  2. 2.Reparto di CardiologiaOspedale di RoveretoTrentoItaly

Personalised recommendations