CARDIOVERSION FOR ATRIAL-FIBRILLATION - N EW CONCEPTS AND STRATEGIES

Restoring sinus rhythm is patients with non-valvular atrial fibrillati on has two objectives: restore haemodynamic performance and reduce the risk of thromboembolism Whether the cardioversion is spontaneous or i nduced with drugs or electroshock, the process itself carries the risk of systemic embolism attributed to the transitory inactivity of the l eft atrium. Current practice of giving anticoagulants at least 4 weeks before electric cardioversion is a compromise between the embolic ris k of cardioversion estimated at 0.4 to 0.8% and haemorrhagic complicat ions related to low blood coagulability estimated at about 1% per year . The advent of transoesophageal echography has made it possible to st udy the atrium in detail in search of thrombi. The result has been a r evolution in our concepts and therapeutic approach to atrial fibrillat ion and cardioversion. Recent studies have shown that ''rapid cardiove rsion'' associated with minimal 48-hour anticoagulation with heparin T V and transoesophageal echography to eliminate a thrombus in the atriu m and/or the atrial appendage can be proposed without increasing the r isk of embolism. Besides simplifying the therapeutic protocols (but at the cost of the semi-invasive nature of the transoesophageal echocard iography), this method also has the merit of restoring atrial function rapidly, particularly in cases of recent onset arrhythmia.