Thromboembolic Complications After Cardioversion of Acute Atrial Fibrillation
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Objectives This study sought to explore the incidence and risk factors of thromboembolic complications after cardioversion of acute atrial fibrillation.Background Anticoagulation therapy is currently recommended after cardioversion of acute atrial fibrillation in patients with risk factors for stroke, but the implementation of these new consensus-based guidelines has been slow.Methods A total of 7,660 cardioversions were performed in 3,143 consecutive patients with atrial fibrillation lasting <48 h in 3 hospitals. For this analysis, embolic complications were evaluated during the 30 days after 5,116 successful cardioversions in 2,481 patients with neither oral anticoagulation nor peri-procedural heparin therapy.Results There were 38 (0.7%; 95% confidence interval [CI]: 0.5% to 1.0%) definite thromboembolic events (31 strokes) within 30 days (median 2 days, mean 4.6 days) after cardioversion. In addition, 4 patients suffered transient ischemic attack after cardioversion. Age (odds ratio [OR]: 1.05; 95% CI: 1.02 to 1.08), female sex (OR: 2.1; 95% CI: 1.1 to 4.0), heart failure (OR: 2.9; 95% CI: 1.1 to 7.2), and diabetes (OR: 2.3; 95% CI: 1.1 to 4.9) were the independent predictors of definite embolic events. Classification tree analysis showed that the highest risk of thromboembolism (9.8%) was observed among patients with heart failure and diabetes, whereas patients with no heart failure and age <60 years had the lowest risk of thromboembolism (0.2%).Conclusions The incidence of post-cardioversion thromboembolic complications is high in certain subgroups of patients when no anticoagulation is used after cardioversion of acute atrial fibrillation. (Safety of Cardioversion of Acute Atrial Fibrillation [FinCV]; NCT01380574).
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New evidence indicates that initiating precardioversion anticoagulation in patients with AF episodes of < 24 hours or even < 12 hours would provide even better safety.
“However, new evidence has emerged that initiating precardioversion anticoagulation in patients with AF episodes of < 24 hours or even < 12 hours would provide even better safety.642,647,[1026][1027][1028]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [642]
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Research works printed but not linked: 1
- Airaksinen et al. JACC Vol. 62, No. 13, 2013 Stroke and Cardioversion of Atrial Fibrillation September 24, 2013:1187-92
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Self-citation
- Authors
- Airaksinen, K. E. J., Grönberg, T., Nuotio, I., Nikkinen, M., Ylitalo, A., Biancari, F., & Hartikainen, J. E. K.
- Affiliations
- Turku University Hospital (FI)
- Kuopio University Hospital (FI)
- Satakunta Central Hospital (FI)
- Oulu University Hospital (FI)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 62
- Issue
- 13
- Pages
- 1187-1192
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W100710028
- Cited by
- 258
- References
- 22
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 29 · 2023: 12 · 2022: 13 · 2021: 22 · 2020: 30 · 2019: 28 · 2018: 21 · 2017: 24 · 2016: 27 · 2015: 18 · 2014: 15 · 2013: 3
- FWCI
- 14.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Finnish Foundation for Cardiovascular Research
- Clinical Research Fund (EVO) of Turku University Hospital
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- acute atrial fibrillation, cardioversion, thromboembolic events, stroke, transient ischemic attack, risk factors, heart failure, diabetes mellitus, age, sex differences, classification trees
- MeSH terms
- Aged, Atrial Fibrillation, Electric Countershock, Female, Finland, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Thromboembolism, Incidence, Logistic Models
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