Prevalence of atrial thrombi in patients with atrial fibrillation/flutter and subtherapeutic anticoagulation prior to cardioversion

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology
G CorradoM Santarone

Abstract

Thromboembolism may complicate electrical cardioversion (ECV) of atrial fibrillation/flutter (AF). The use of 3 weeks of warfarin before ECV results in a substantial reduction of thromboembolic complications. Nevertheless, in patients scheduled for ECV subtherapeutic INR levels are common. We sought to assess the prevalence and the predictors of atrial thrombi in patients affected with sustained AF in whom subtherapeutic INR values were detected in the 3 weeks preceding scheduled ECV. Forty-one patients with persistent AF and > or =3 weeks warfarin anticoagulation who exhibited subtherapeutic INR values in the last 3 weeks underwent a transoesophageal echocardiogram (TOE) before a scheduled ECV. A left atrial appendage (LAA) thrombus was diagnosed on TOE in four patients (9.8%). Patients with thrombus had lower INR values (1.45+/-0.09 vs 1.72+/-0.20; p=0.0068), lower LAA emptying velocities (13.75+/-4.5 vs 25.86+/-12.4 cm/s; p=0.0313) and higher prevalence of atrial smoke (100 vs 37.8%,p=0.03). Subtherapeutic levels of anticoagulation before elective ECV of AF may expose patients to post-ECV thromboembolic sequelae, especially in patients with lowest INR values. Current recommendations of a full course of therapeutic anticoagul...Continue Reading

Citations

Oct 1, 2010·North American Journal of Medical Sciences·Ezekiel Uba Nwose, Nathan Cann
Jan 31, 2006·American Heart Journal·Allan L KleinUNKNOWN ACUTE Steering and Publications Committee for the ACUTE Investigators
Oct 26, 2012·Circulation. Arrhythmia and Electrophysiology·Kunihiro NishidaStanley Nattel
Jun 28, 2006·Journal of Cardiovascular Medicine·Giovanni CorradoMauro Santarone
Jul 27, 2012·European Heart Journal Cardiovascular Imaging·Anita C BoydLiza Thomas
May 1, 2012·Future Cardiology·Neil MangroliaPeter J Pugh
Aug 8, 2012·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·F ZoppoE Bertaglia

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