title: Cardioversion under the guidance of transesophageal echochardiograhy in persistent atrial fibrillation: results with low molecular weight heparin.
abstract: BACKGROUND
  Transesophageal echocardiography (TEE) guided cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation (AF). Anticoagulation at the time of and after cardioversion is necessary to prevent formation of new thrombus during atrial stunning period. We aimed to evaluate the efficacy and safety to TEE guided cardioversion with low molecular weight heparin (LMWH) in patients with atrial fibrillation.
  
  
  METHODS
  We followed up 208 patients with persistent AF (mean age: 65.5+/-10.2 years) who were attempted TEE guided cardioversion. LMWH were used as an anticoagulant and warfarin therapy was continued.
  
  
  RESULTS
  Cardioversion were performed in 183 patients. Sinus rhythm restored in 144 patients (78.7%). Mean follow up duration was 155 days. No cardiac death occurred. In the early follow up period (within 30 day) one thromboembolic event (0.54%) occurred in a patient who was cardioverted. Two patients who had not been cardioverted because of left atrial thrombus presented embolic stroke, one in early and another in late follow up period. All embolic complications occurred in patients who had been taking warfarin and whose INR level was subtherapeutic at the time of stroke. Sinus rhythm was maintained in 64% and total hemorrhagic complications occurred in 4.8% of the patients in long-term follow-up.
  
  
  CONCLUSIONS
  TEE guided cardioversion with a short-term anticoagulation protocol using low molecular weight heparin is a safe and effective method in restoring and maintaining sinus rhythm and enables us to make earlier cardioversion in atrial fibrillation.
authors.affiliation: Department of Cardiology, Dokuz Eylul University School of Medicine, Inciralti 35340 Izmir, Turkey. bahari.akdeniz@deu.edu.tr
authors.forename: Bahri
authors.initials: B
authors.lastname: Akdeniz
authors.forename: Sonay
authors.initials: S
authors.lastname: Türker
authors.forename: Volkan
authors.initials: V
authors.lastname: Oztürk
authors.forename: Ozer
authors.initials: O
authors.lastname: Badak
authors.forename: Taha
authors.initials: T
authors.lastname: Okan
authors.forename: Ozgür
authors.initials: O
authors.lastname: Aslan
authors.forename: Omer
authors.initials: O
authors.lastname: Kozan
authors.forename: Onder
authors.initials: O
authors.lastname: Kirimli
authors.forename: Deniz
authors.initials: D
authors.lastname: Aytekin
authors.forename: Nezihi
authors.initials: N
authors.lastname: Bariş
authors.forename: Sema
authors.initials: S
authors.lastname: Güneri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000628:therapy*; D003131:Combined Modality Therapy; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight