© 2004 by European Society of Cardiology
Copyright © 2003, The European Society of Cardiology
Prevalence of atrial thrombi in patients with atrial fibrillation/flutter and subtherapeutic anticoagulation prior to cardioversion
aUnità Operativa di Cardiologia, Ospedale Valduce, Como, Italy
bUnità Operativa di Neurologia, AO Ospedale Civile di Vimercate, Italy
Received 13 March 2003; received in revised form 17 June 2003; accepted after revision 26 June 2003.
* Corresponding author. Unità Operativa di Cardiologia, Ospedale Generale Valduce Via Dante, 11 22100 Como, Italy. Fax: +39-031-308-047. gcorr{at}iol.it
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Abstract |
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Aims: Thromboembolism may complicate electrical cardioversion (ECV) of atrial fibrillation/flutter (AF). The use of 3 weeks of warfarin before ECV results in a substantial reduction of thromboembolic complications. Nevertheless, in patients scheduled for ECV subtherapeutic INR levels are common. We sought to assess the prevalence and the predictors of atrial thrombi in patients affected with sustained AF in whom subtherapeutic INR values were detected in the 3 weeks preceding scheduled ECV.
Methods and results: Forty-one patients with persistent AF and 
3 weeks warfarin anticoagulation who exhibited subtherapeutic INR values in the last 3 weeks underwent a transoesophageal echocardiogram (TOE) before a scheduled ECV. A left atrial appendage (LAA) thrombus was diagnosed on TOE in four patients (9.8%). Patients with thrombus had lower INR values (1.45±0.09 vs 1.72±0.20; p = 0.0068), lower LAA emptying velocities (13.75±4.5 vs 25.86±12.4 cm/s; p = 0.0313) and higher prevalence of atrial smoke (100 vs 37.8%, p = 0.03).
Conclusions: Subtherapeutic levels of anticoagulation before elective ECV of AF may expose patients to post-ECV thromboembolic sequelae, especially in patients with lowest INR values. Current recommendations of a full course of therapeutic anticoagulation before ECV of persistent AF should be firmly observed.
Keywords: anticoagulation; echocardiography; fibrillation
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