title: Safety of electrical cardioversion in patients with previous embolic events.
abstract: OBJECTIVE
  To assess thromboembolic complications in cardioversions in patients with atrial fibrillation or flutter and a previous embolic event.
  
  
  METHODS
  The study population consisted of 104 patients with previous embolic events who underwent 128 electrical cardioversions for termination of atrial fibrillation or flutter. The primary outcome measure was successful cardioversion.
  
  
  RESULTS
  Anticoagulants were administered in 118 procedures (92%). Cardioversion was successful in 108 (84%) of the 128 procedures. Only 1 embolic event occurred within 30 days after cardioversion (incidence, 0.9% of successful procedures; 95 % confidence interval, 0.02%-5.3%). The single embolic event was a transient neurologic deficit occurring 22 days after cardioversion in a patient with previous atrial fibrillation. This patient had a sub-therapeutic level of anticoagulation. Transesophageal echocardiography revealed no spontaneous echo contrast or thrombi before the procedure. No thromboembolism was noted in patients who had therapeutic anticoagulation or in those with failed cardioversion.
  
  
  CONCLUSIONS
  Patients with previous embolism are not at additional risk of thromboembolic complications after cardioversion if anticoagulation is adequate.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: F
authors.initials: F
authors.lastname: Gentile
authors.forename: B K
authors.initials: BK
authors.lastname: Khandheria
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: K N
authors.initials: KN
authors.lastname: Burger
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001282:Atrial Flutter / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016001:Confidence Intervals; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013923:Thromboembolism / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants