J. Mayet et al., CARDIOVERSION OF ATRIAL ARRHYTHMIAS - AUDIT OF ANTICOAGULATION MANAGEMENT, Journal of the Royal College of Physicians of London, 31(3), 1997, pp. 313-316
Patients undergoing cardioversion for chronic atrial fibrillation shou
ld receive anticoagulation for three weeks before and four weeks after
the procedure. Patients with atrial flutter and acute atrial fibrilla
tion are also at risk of thromboembolic complications, so they too sho
uld be anticoagulated for cardioversion. Of the 36 acutely admitted pa
tients who were cardioverted, 18 were in atrial fibrillation and 18 in
atrial flutter. All except three of those in fibrillation were antico
agulated with heparin before cardioversion, but only seven received wa
rfarin after cardioversion. Of those in flutter, 10 received heparin a
nd eight received no anticoagulation before cardioversion. One patient
underwent transoesophageal echocardiography before cardioversion to e
xclude atrial thrombi. Only two patients received warfarin for a month
after cardioversion. Of the 20 elective cardioversions, 10 were in at
rial fibrillation and 10 in atrial flutter. Five of those in fibrillat
ion had received at least three weeks' treatment with warfarin before
cardioversion and two underwent transoesophageal echocardiography; the
other three received either up to two hours of heparin or no anticoag
ulation before cardioversion. Only five patients received warfarin for
a month after cardioversion. Nine of those in flutter received a few
hours of heparin before cardioversion and one was not anticoagulated;
none underwent transoesophageal echocardiography or received warfarin
after cardioversion. The results of this audit demonstrate that antico
agulation for atrial arrhythmias was inconsistent and often inadequate
. A formal anticoagulation policy for cardioversion has now been adopt
ed.