THROMBOEMBOLISM FOLLOWING CARDIOVERSION OF COMMON ATRIAL-FLUTTER - RISK-FACTORS AND LIMITATIONS OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Based on multiple recent studies, anticoagulant therapy is recommended prior to elective cardioversion for patients with atrial fibrillation of more than 24 h duration, The value of anticoagulation in patients with atrial nutter, however, is less well established, Published recom mendations for pericardioversion anticoagulation of atrial fibrillatio n often do not extend to patients with atrial nutter, We evaluated the risk of thromboembolism in our patient population undergoing cardiove rsion for atrial nutter. Over a period of 30 months, clinically indica ted electrical cardioversions were performed in 41 patients with ''com mon'' atrial nutter, Sixteen of these patients underwent transesophage al echocardiograms immediately prior to cardioversion to exclude a lef t atrial thrombus. Three of the 41 patients with atrial nutter develop ed neurologic ischemic syndromes within 48 h of elective cardioversion . All three patients who developed ischemic neurologic complications h ad undergone transesophageal echocardiography immediately prior to car dioversion and did not have any evidence of left atrial clot, One pati ent had cardiomyopathy and the other two had left ventricular hypertro phy, Thus, electrical cardioversion without anticoagulation in patient s with atrial nutter and associated heart disease is associated with a risk of thromboembolic events, A normal transesophageal echocardiogra m is of doubtful value in prevention of thromboembolic complications.