Periprocedural Anticoagulation for Cardioversion of Acute Onset Atrial Fibrillation and Flutter: Evidence Base for Current Guidelines

Publication date: Available online 12 June 2019Source: Canadian Journal of CardiologyAuthor(s): Jason G. Andrade, L. Brent MitchellABSTRACTThe practice of electrical or pharmacological cardioversion (CV) to restore sinus rhythm in patents with symptomatic atrial fibrillation (AF) or atrial flutter (AFL) has been a part of clinical practice for over 100 years. For almost as long as CV has been performed, it has been recognised that the act of restoring sinus rhythm is associated with an increased risk of stroke and systemic embolism, and that oral anticoagulation (OAC) therapy can be used to prevent peri-CV thromboembolism. While it has been widely accepted that OAC therapy is necessary to prevent thromboembolism in patients with chronic AF/AFL undergoing cardioversion, previous clinical practice recommendations have suggested that OAC may be omitted in patients at low risk of stroke. However, in recent years, evidence has emerged from several sources challenging these historical conventions. In 2018 the Canadian Cardiovascular Society (CCS) AF guidelines updated the previous recommendations regarding cardioversion of acute onset atrial fibrillation, and the use of peri-cardioversion anticoagulation. The article presented herein presents an extensive review of the evidence informing the previous recommendations, as well as the novel evidence that informed the change in recommendations. In addition, the current CCS AF guideline recommendations are examined within the context of...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research