Clinical study
Thromboembolic complications after electrical cardioversion in patients with atrial flutter

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Abstract

Purpose

To determine the incidence of thromboembolic complications after cardioversion in patients with atrial flutter.

Subjects and methods

We reviewed 615 electrical cardioversions performed electively in 493 patients with atrial flutter. Embolic complications were evaluated during the 30 days after cardioversion. Follow-up data were obtained by follow-up visits and by contacting the treating physician.

Results

Anticoagulants had been administered in 415 cardioversions (67%). Cardioversion was successful in 570 procedures (93%). Three embolic events (in 3 patients) occurred in the 30 days after 550 successful cardioversions with completed follow-up (0.6% of successful procedures; 95% confidence interval, 0.1% to 1.6%). Two of the 3 patients had not been anticoagulated, whereas the third patient had subtherapeutic oral anticoagulation. No embolic event occurred in procedures performed with adequate anticoagulation. The incidence of embolism in patients regardless of subtherapeutic anticoagulation was 1% (3 of 303 successful cardioversions).

Conclusions

We observed a low (0.6%) incidence of postcardioversion thromboembolic complications in patients with atrial flutter. Embolic events did not occur in patients with adequate anticoagulation.

Section snippets

Study population

This was a retrospective analysis of 615 electrical cardioversions performed electively in 493 patients at the Mayo Clinic, Rochester, Minnesota, from 1990 through 1994. Patients were identified consecutively through a registry of cardioversions performed at our institution. Atrial flutter was defined as an organized atrial tachycardia of 240 beats/min or more. The duration of atrial flutter, defined by documentation of arrhythmias on echocardiographic recordings, was less than 1 month in 439

Results

The mean age of the study patients was 66 ± 15 years. There were 362 men (73%). Associated diseases were hypertension in 218 patients (44%), diabetes mellitus in 87 (18%), coronary artery disease in 214 (43%), valvular heart disease in 126 (26%), and cardiomyopathy in 90 (18%). Previous atrial fibrillation was documented in 283 procedures (46%).

Procedures that were performed without anticoagulation were associated with a shorter duration of atrial flutter, lower left atrial and left ventricular

Discussion

In this study, successful restoration of sinus rhythm after atrial flutter was achieved in 93% of the cardioversion procedures. Failure of cardioversion was significantly associated with older age (P = 0.01) and longer duration of atrial flutter (P = 0.02). Diabetes mellitus, valvular heart disease, cardiomyopathy, and coronary artery disease had no impact on the success of cardioversion, suggesting that cardioversion should not be deferred in patients presenting with atrial flutter on the

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