title: Assessment of silent microembolism by magnetic resonance imaging after cardioversion in atrial fibrillation.
abstract: OBJECTIVE
  To study electrical cardioversion in patients with atrial fibrillation as a potential cause of acute ischemic brain lesions.
  
  
  METHODS
  We performed prospective analysis of 62 consecutive patients (62 [10] years, 16 female). All of them were anticoagulated for at least 3 weeks with an international normalized ratio of 2.69 (0.66). In all cases a magnetic resonance imaging of the brain was performed before and 24h after the cardioversion, including diffusion-weighted sequences. A neurological exploration was also performed before and after the procedure, using the modified Ictus on the National Institute of Health Stroke Scale and the modified Rankin scale. Written informed consent was obtained in all cases.
  
  
  RESULTS
  Of the 62 patients, 51 (85%) reverted to sinus rhythm. The neurological examination showed no changes after cardioversion. The pre-procedure magnetic resonance imaging showed microvascular disease in 35 (56%), including 2 patients with known cerebrovascular disease, and did not depict new clinically silent ischemic areas after cardioversion.
  
  
  CONCLUSIONS
  After electrical cardioversion no acute ischemic lesions in the brain nor alteration in the neurological scales were found. Nevertheless, in 35 patients (56%) with persistent atrial fibrillation, the magnetic resonance imaging showed clinically silent ischemic lesions.
authors.affiliation: Servicio de Cardiología, Hospital Povisa, Vigo, Pontevedra, Spain. macrisvc@yahoo.es
authors.forename: María
authors.initials: M
authors.lastname: Vázquez
authors.forename: Eloísa
authors.initials: E
authors.lastname: Santos
authors.forename: Iria
authors.initials: I
authors.lastname: Rodriguez
authors.forename: Antonio
authors.initials: A
authors.lastname: Pato
authors.forename: Manuel
authors.initials: M
authors.lastname: Vilar
authors.forename: Juan C
authors.initials: JC
authors.lastname: Arias
authors.forename: Rafael
authors.initials: R
authors.lastname: Fernández
authors.forename: Isabel
authors.initials: I
authors.lastname: Costas
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ghioldi
authors.forename: Marcelo
authors.initials: M
authors.lastname: Sanmartin
authors.forename: Francisco
authors.initials: F
authors.lastname: Tardáguila
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy*; D001921:Brain / Q000473:pathology; D004554:Electric Countershock / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D020766:Intracranial Embolism / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011446:Prospective Studies; D012307:Risk Factors