G. Molon, G. Canali, P. Girardi,
F. Castagna, G.L. Ferri, F. Stefanini*, G.C. Salazzari.
Department of Cardiology, *Department of Emergency, "S. Cuore"
Hospital, Negrar, Italy
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From January 1993 to June 1997 154 patients underwent
221 external electrical cardioversions for atrial fibrillation; 86 (56%) were males and 68
(44%) females. Age 30-86 years, average 66. Hypertensive heart diseases were 33%, cardiac
heart failure 14%, valvular diseases 12%, other heart diseases 22%; 19% were patients with
no evident cardiac diseases (lone atrial fibrillation).
Before performing cardioversion patient's medical history, echocardiogram and chest
X-ray were obtained; patients were divided in two groups on the ground of arrhythmia's
onset and risk of stroke:
- 121 patients (78%), with onset of atrial fibrillation > 48 hours or
moderate/severe risk of stroke, were anticoagulated with Warfarin in order to obtain a
prothrombin time international normalized ratio (INR) range beetwen 2 and 3; after 3 weeks
direct current cardioversion was attempted. Anticoagulation was continued at least for 4
weeks after successful cardioversion. Cardioversion was not taken before 1 month from
atrial fibrillation onset;
- 33 patients (22%), with onset < 48 hours and low risk of stroke, were not
anticoagulated and cardioversion was performed after failure of pharmacologyc attempts or,
when close to the limit of 48 hours, directly to avoid the long-term anticoagulation, with
its connected risks and disconforts, and to prevent the electrical remodeling of the
atria.
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