title: Low stroke risk after elective cardioversion of atrial fibrillation: an analysis of the Flec-SL trial.
abstract: BACKGROUND
  Current recommendations for anticoagulation management during cardioversion are largely based on historical data and expert consensus.
  
  
  RESULTS
  To characterize current practice of anticoagulation during and after elective cardioversion for AF and the risk of stroke and bleeding events, all patients enrolled into the Flec-SL trial were analyzed for stroke/transient ischemic attack and major bleeds after cardioversion. Flec-SL (ISRCTN62728743, NCT00215774) enrolled 635 patients (mean age 63.7 ± 10.9, 66% male). 629 (99.1%) patients received periprocedural anticoagulation, 556 (87.6%) were adequately anticoagulated following current recommendations. 202 (31.8%) patients underwent transesophageal echocardiography-guided cardioversion. Electrical cardioversion was used in 508 patients (80.0%), pharmacological cardioversion in 127 (20%). Six patients suffered from stroke (n = 5) or transient ischemic attack (3 TIAs in 1 patient, event rate 0.9%, 95% CI 0.4-2.1), five others from major bleeds (event rate 0.8%, 95% CI 0.3-1.9), consistent with the low reported event rates in prior studies. Three strokes occurred in the first 5 days after cardioversion. Events were independent of type of cardioversion or the use of TEE to exclude thrombi.
  
  
  CONCLUSIONS
  Strokes are rare in this large, prospectively followed cohort of patients undergoing cardioversion for AF and receiving antithrombotic therapy following local routine. These results support adherence to current recommendations for anticoagulation during cardioversion of AF.
authors.affiliation: Centre for Cardiovascular Sciences, School for Clinical and Experimental Medicine, University of Birmingham, and SWBH NHS Trust, Birmingham, UK.
authors.forename: Stavros
authors.initials: S
authors.lastname: Apostolakis
authors.forename: Karl Georg
authors.initials: KG
authors.lastname: Haeusler
authors.forename: Michael
authors.initials: M
authors.lastname: Oeff
authors.forename: Andras
authors.initials: A
authors.lastname: Treszl
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Parade
authors.forename: Alexander
authors.initials: A
authors.lastname: Samol
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D004554:Electric Countershock / Q000379:methods* / Q000639:trends; D005260:Female; D005424:Flecainide / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D005424:Flecainide
keywords: Anticoagulation; Atrial fibrillation; Cardioversion; Major bleeding; Stroke