Anticoagulation in conventional versus transesophageal echocardiography (TEE) guided cardioversion (CV) of atrial fibrillation (AF)

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with thrombembolic events and hemodynamic impairment that results in considerable morbidity, mortality and cost. Current guidelines recommend that patients receive anticoagulants for 3-4 weeks before and 4 weeks after cardioversion (CV). Transesophageal echocardiography (TEE) guided cardioversion with low-molecular-weight heparin (LMWH) may reduce the duration of anticoagulation. Aim: We compared duration of anticoagulation in conventional approach to CV and TEE guided cardioversion with LMWH. Methods and results: From october 2001 to december 2003 179 patients admitted with AF of more than 48 hours duration were included in our study. 97 patients were treated with conventional approach to CV and 82 patients with TEE guided cardioversion. Clinical characteristic of patients in both groups were the same, regarding underlying disease, age and sex. CV was cancelled in all patients with atrial thrombi (n=10). The duration of pericardioversion anticoagulation in conventional treated group was 22 weeks and in the group with TEE with LMWH 4 weeks. Conclusions: Administration of LMWH in conjunction with TEE reduces the duration of pericardioversion anticoagulation from 22 weeks to 4 weeks.