Safety of electrical cardioversion in patients with atrial fibrillation

• Published in: Mayo Clinic proceedings Vol. 77; no. 9; pp. 897 - 904
• Main Authors: GENTILE, Federico, ELHENDY, Abdou, KHANDHERIA, Bijoy K, SEWARD, James B, LOHSE, Christine M, SHEN, Win-Kuang, BAILEY, Kent R, MONTGOMERY, Samantha C, BURGER, Kelli N, TAJIK, A. Jamil
• Format: Journal Article
• Language: English
• Published: Rochester, MN Mayo Medical Ventures 01.09.2002; Elsevier Limited
• Subjects: Aged; Anticoagulants - therapeutic use; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - therapy; Biological and medical sciences; Confidence Intervals; Diabetes Complications; Diseases of the cardiovascular system; Echocardiography; Electric Countershock - adverse effects; Female; Humans; Hypertension - complications; Incidence; Logistic Models; Male; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Factors; Thromboembolism - diagnostic imaging; Thromboembolism - drug therapy; Thromboembolism - epidemiology; Thromboembolism - etiology; Thromboembolism - prevention & control; Time Factors; United States - epidemiology; Human; Intensive cardiocirculatory care; Arrhythmia; Atrial fibrillation; Instrumentation therapy; Cardiovascular disease; Cardioversion; Galvanic current; Excitability disorder; Incidence; Vascular disease; Treatment; Heart disease; Complication; Safety; Thromboembolism
• DOI: 10.1016/S0025-6196(11)62255-6
• ISSN: 0025-6196

To determine the incidence of thromboembolic complications after electively performed electrical cardioversion in patients with atrial fibrillation and to assess the clinical variables associated with an increased risk of thromboembolism after cardioversion. This is a retrospective analysis of 834 successful electrical cardioversions performed in 717 patients from 1990 through 1994. Outcome measures included embolic complications at 1-month follow-up after cardioversion and logistic regression models to measure the associations among clinical, anticoagulation, and thromboembolic events and to identify independent predictors of these events. The rate of embolic events after cardioversion was low (0.9%; 95% confidence interval, 0.4%-1.8%). Patients with a therapeutic international normalized ratio had no embolic events. Adequate anticoagulation was independently associated with reduced risk of thromboembolism. Hypertension and diabetes mellitus were independently associated with increased risk of embolization. Adequate anticoagulation reduced the risk of embolization after cardioversion. Diabetes mellitus and hypertension are independently associated with increased risk of embolization early after cardioversion.