Safety of electrical cardioversion in patients with atrial fibrillation.
OBJECTIVE
To determine the incidence of thromboembolic complications after electively performed electrical cardioversion in patients with atrial fibrillation and to assess the clinical variables associated with an increased risk of thromboembolism after cardioversion.


METHODS
This is a retrospective analysis of 834 successful electrical cardioversions performed in 717 patients from 1990 through 1994. Outcome measures included embolic complications at 1-month follow-up after cardioversion and logistic regression models to measure the associations among clinical, anticoagulation, and thromboembolic events and to identify independent predictors of these events.


RESULTS
The rate of embolic events after cardioversion was low (0.9%; 95% confidence interval, 0.4%-1.8%). Patients with a therapeutic international normalized ratio had no embolic events. Adequate anticoagulation was independently associated with reduced risk of thromboembolism. Hypertension and diabetes mellitus were independently associated with increased risk of embolization.


CONCLUSIONS
Adequate anticoagulation reduced the risk of embolization after cardioversion. Diabetes mellitus and hypertension are independently associated with increased risk of embolization early after cardioversion.
Gentile
Federico
F
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Elhendy
Abdou
A
Khandheria
Buoy K
BK
Seward
James B
JB
Lohse
Christine M
CM
Shen
Win-Kuang
WK
Bailey
Kent R
KR
Montgomery
Samantha C
SC
Burger
Kelli N
KN
Tajik
A Jamil
AJ
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D016001:Confidence Intervals; D048909:Diabetes Complications; D004452:Echocardiography; D004554:Electric Countershock / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D000925:Anticoagulants