title: Low-molecular-weight heparin in transesophageal echocardiography-guided cardioversion of atrial fibrillation.
abstract: Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with thromboembolic events and hemodynamic impairment that results in considerable morbidity, mortality, and cost. Cardioversion to sinus rhythm is a common approach to the treatment of these patients. However, cardioversion is associated with the risk of thromboembolism. Current guidelines recommend that patients receive anticoagulants for 3-4 weeks before and 4 weeks after cardioversion. With the development of transesophageal echocardiography (TEE), the risk of thromboembolism and alternative anticoagulation strategies have been evaluated in patients with atrial fibrillation. Administration of low-molecular-weight heparin (LMWH) in conjunction with TEE offers several advantages over unfractionated heparin. Limited data suggest that LMWH in this setting is as effective, is safer, and may be more cost-effective than unfractionated heparin. Ongoing research will identify definitively the optimal strategy for pericardioversion anticoagulation.
authors.affiliation: Department of Pharmacy Practice, School of Pharmacy, Temple University, Philadelphia, Pennsylvania 19140, USA. awodling@temple.edu
authors.forename: Anna M
authors.initials: AM
authors.lastname: Wodlinger
authors.forename: John A
authors.initials: JA
authors.lastname: Pieper
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000628:therapy; D002986:Clinical Trials as Topic; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D006495:Heparin, Low-Molecular-Weight