Thromboembolic Complications After Cardioversion of Acute Atrial Fibrillation: The FinCV Study

Jul 10, 2013
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Authors:
Airaksinen KE, Gronberg T, Nuotio I, et al.
Citation:
J Am Coll Cardiol 2013;Jul 10:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

What is the risk of stroke associated with transthoracic cardioversion of atrial fibrillation (AF) in the absence of anticoagulation?

Methods:

In this retrospective database analysis at three hospitals, 2,481 patients (mean age 61 years) with AF for <48 hours who underwent cardioversion without anticoagulation were identified. The primary outcome was thromboembolic events within 30 days of cardioversion.

Results:

The 2,481 patients underwent 5,362 cardioversions, with a 95.4% success rate. The incidence of thromboembolic events in the 30 days post-cardioversion (median 2 days) was 0.7%, including a 0.6% incidence of stroke. The only independent predictors of thromboembolic events were age (odds ratio [OR], 1.05), female gender (OR, 2.1), heart failure (OR, 2.9), and diabetes (OR, 2.3). Patients with heart failure and diabetes had the highest risk of thromboembolism (9.8%). Patients ages <60 years without heart failure had the lowest risk of thromboembolism (0.2%).

Conclusions:

The risk of thromboembolic complications in the absence of anticoagulation after cardioversion of AF <48 hours in duration is very low in the absence of risk factors for stroke, but unacceptably high in patients with risk factors.

Perspective:

Current guidelines for anticoagulation in patients undergoing cardioversion of AF are based on the duration of AF. Anticoagulation is recommended if the AF duration is >48 hours or unknown. If the AF duration is <48 hours, anticoagulation is recommended in patients with risk factors for stroke. Although the recommendations dealing with short-lived AF are very reasonable, there has been little evidence underlying the recommendations. This study is important because it provides substantial evidence that validates current practice guidelines.

Keywords: Thromboembolism, Incidence, Blood Coagulation, Stroke, Warfarin, Electric Countershock, Heart Failure, Risk Factors, Diabetes Mellitus


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