Coagulation indicators in patients with paroxysmal atrial fibrillation: Effects of electric and pharmacologic cardioversion

The aim of this study was to determine whether paroxysmal atrial fibrillati on (PAF) and/or restoration to sinus rhythm with electric or pharmacologic cardioversion induce modifications to the coagulation system. Thirty-five p atients with PAF undergoing either electric (n = 11) or pharmacologic (n = 24) cardioversion were studied. Fibrinopeptide A and D-dimer blood samples were taken immediately before and after cardioversion at different interval s. When compared with the control group (n = 70), the precardioversion fibr inopeptide A plasma values were significantly elevated (11.8 vs 2.5 ng/ml). Fibrinopeptide A plasma values were significantly reduced 5 minutes after cardioversion (11.8 vs 5.3 ng/mL) and remained stable throughout the follow -up sequential measurements. D-dimer plasma values were significantly incre ased (measured at 12 hours and at day 7) in patients who underwent electric al cardioversions only. A positive correlation (R-2 = 0.76) was found betwe en the energy delivered for cardioversion to sinus rhythm and D-dimer plasm a values on day 7. in patients with PAF, levels of fibrinopeptide A, an ind icator of coagulation activation, are elevated and soon reduced by the rest oration of sinus rhythm. Electric, but not pharmacologic, cardioversion ind uces an early activation of the fibrinolytic system.