Early cardioversion of atrial fibrillation and atrial flutter guided by transoesophageal echocardiography. A single centre 8·5-year experience

Corrado, Giovanni; Santarone, Mauro; Beretta, Sandro; Tadeo, Giorgio; Tagliagambe, L M; Foglia-Manzillo, Giovanni; Spata, Manuela; Miglierina, Emilio; Acquati, F

doi:10.1053/eupc.1999.0093

Cited by 17 publications

(7 citation statements)

References 48 publications

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“…These findings suggest that hs-CRP levels are associated with AF recurrence. In our study, the success rate of CV and the rate of AF recurrence at 12 months were similar to previous data [19,20]. …”

Section: Discussionsupporting

confidence: 80%

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

Çelebi¹,

Celebi²,

Canbay³

et al. 2011

Cardiology

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Objective: Recent studies have shown that high-sensitivity C-reactive protein (hs-CRP) measured before cardioversion (CV) plays a significant role in predicting atrial fibrillation (AF) relapse. The time course of changes in hs-CRP after successful electrical CV remains controversial. The aim of the present study was to assess the prognostic value of pre- and post-CV hs-CRP levels in predicting the long-term risk of AF. Additionally, we evaluated changes in hs-CRP levels over time following a successful CV. Methods: This prospective study comprised 216 patients with persistent AF who underwent CV (mean age 51.94 ± 8.07 years; 55.6% men). hs-CRP levels were examined in all patients, and blood samples were taken prior to and 1, 2, 7 and 30 days after CV. AF relapse was determined by 24-hour ambulatory electrocardiogram (ECG) monitoring and 12-lead standard ECG during 12 months of follow-up. We further divided the study population into two groups according to their rhythm at the end of the follow-up period (group A: patients with AF at the end of follow-up; group B: patients with sinus rhythm at the end of the follow-up period). Results: The AF recurrence rate was 42.2% throughout the 12-month follow-up period. The basal hs-CRP levels were higher in patients with an AF relapse than in those without (1.68 ± 0.57 vs. 1.12 ± 0.53 mg/dl; p < 0.01). The hs-CRP levels were significantly decreased at 30 days in group B, whereas there was no significant decrease in group A (from 1.12 ± 0.53 to 0.69 ± 0.33 mg/dl, p < 0.01, and from 1.68 ± 0.57 to 1.69 ± 0.76 mg/dl, p > 0.05, respectively). By multivariate Cox analysis, the independent predictors of AF relapse time points were the basal and day-2 hs-CRP levels. Receiver operating characteristic curve analysis showed that the cutoff value of hs-CRP on the 2nd day for predicting AF relapse was 1.85 mg/dl, with a sensitivity of 62%, a specificity of 82%, a positive predictive value of 85.7% and a negative predictive value of 81.6%. Conclusion: The hs-CRP levels both prior to and after CV predict the long-term risk of AF relapse. In the present study, hs-CRP levels were significantly decreased in patients who remained in sinus rhythm at the end of the study. In contrast, hs-CRP levels remained high throughout the follow-up in patients with an AF relapse.

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Section: Discussionsupporting

confidence: 80%

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

Çelebi¹,

Celebi²,

Canbay³

et al. 2011

Cardiology

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“…Stoddard 28 demonstrated that patients receiving anticoagulation following conventional treatment had a higher prevalence of both thorombus and SEC in LA compared with patients who underwent cardioversion early. Corrado 30 demonstrated that patients with and <4 weeks duration of AF had a significantly better immediate success rate of CV than those with longer duration of AF (96.9% versus 85%); improved outcome was maintained at 1 month. This study helped show that not only did patients tolerate abbreviated anticoagulation, but also earlier termination of AF had a positive effect on immediate success and maintenance of sinus rhythm.…”

Section: Reviews Continuedmentioning

confidence: 98%

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Patel

Flaker

2007

Clinical Cardiology

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The 2006 American Heart Association guidelines for management of patients with atrial fibrillation state: ''For patients with no identifiable thrombus in the left atrium (LA) or left atrial appendage (LAA), cardioversion (CV) is reasonable immediately after anticoagulation with unfractionated heparin. Thereafter, continuation of oral anticoagulation is reasonable for an anticoagulation period of at least 4 weeks.'' For patients with thrombus identified by transesophageal echocardiography, guidelines recommend therapeutic oral anticoagulation for 3 weeks prior to and 4 weeks after elective cardioversion.Patients with spontaneous echo contrast spontaneous echo contrast (SEC) identified by transesophageal echocardiogram (TEE) have a high risk of thromboembolic events, 1 -8 however, the guidelines do not address whether patients with SEC without thrombus can be safely cardioverted. This paper reviews the literature describing the pathogenesis of SEC, how it is detected, and whether elective cardioversion is safe.On the basis of our review, we believe that the risk of cardioembolic stroke after cardioversion of a patient with SEC is low, regardless of anticoagulation. The safe conclusion is that patients with SEC on TEE should receive therapeutic anticoagulation prior to cardioversion if possible and early cardioversion is not contraindicated.

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“…The flowchart of the systematic review is depicted in Figure . Of the 8,468 articles screened, 17 articles were selected for the final analyses . The initial and follow‐up data of the articles included in the final analyses are listed in Table and in Table , respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Only two of the 17 studies included in the final review noted inclusion of subjects with rheumatic disease . Corrado et al.…”

Section: Resultsmentioning

confidence: 99%

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Oral anticoagulation and left atrial thrombi resolution in nonrheumatic atrial fibrillation or flutter: A systematic review and meta‐analysis

Wang

Sather

Hussain

et al. 2018

Pacing Clinical Electrophis

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Early cardioversion of atrial fibrillation and atrial flutter guided by transoesophageal echocardiography. A single centre 8·5-year experience

Cited by 17 publications

References 48 publications

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Oral anticoagulation and left atrial thrombi resolution in nonrheumatic atrial fibrillation or flutter: A systematic review and meta‐analysis

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