title: Incidence of cerebral embolism after cardioversion of atrial fibrillation: a prospective study with transesophageal echocardiography and cerebral magnetic resonance imaging.
abstract: BACKGROUND
  After cardioversion of atrial fibrillation the risk for cerebral embolism is increased. There is little knowledge about the incidence of cerebral embolism for patients with transesophageal echocardiography (TEE)-guided cardioversion under oral anticoagulation.
  
  
  METHODS
  Consecutive patients with atrial fibrillation and TEE-guided cardioversion were included in the study. We performed serial TEE studies, Holter electrocardiography, cranial magnetic resonance imaging, and clinical examinations during a period of 4 weeks before and after cardioversion. Oral anticoagulation was continued or initiated in all patients.
  
  
  RESULTS
  During the observation period 6 of 127 (4.7%) patients had new embolic lesions after cardioversion documented on cerebral magnetic resonance imaging. Patients with an event were significantly older (P = .04) and had a larger left atrium (P = .04) than patients without event.
  
  
  CONCLUSIONS
  Patients with atrial fibrillation and oral anticoagulation have a low rate of clinical apparent cerebral embolism after TEE and anticoagulation-guided cardioversion. The rate of silent cerebral embolism is almost 5%. Age and left atrial size are predictors for an event.
authors.affiliation: Department of Medicine-Cardiology, University of Bonn, Bonn, Germany. bernhardt@cardiomrt.de
authors.forename: Peter
authors.initials: P
authors.lastname: Bernhardt
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Berndt
authors.initials: B
authors.lastname: Lüderitz
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants