Antikoagulation nach Kardioversion

Abstract

Atrial fibrillation significantly increases the risk of stroke or systemic embolism. Antithrombotic treatment should be applied according to the individual stroke risk irrespective of whether a rate control or rhythm control strategy had been implemented. Simple risk stratification scores are available to assess the individual stroke risk in daily practice. Cardioversion of atrial fibrillation is associated with an increased stroke risk due to a transient mechanical atrial dysfunction referred to as „atrial stunning“. According to current guidelines, an effective anticoagulation for 4 weeks after cardioversion is recommended in all patients with an atrial fibrillation episode lasting longer than 48 hours or of unknown duration and in patients with an atrial fibrillation episode less than 48 hours and risk factors for stroke. Since cardioversion does not prevent atrial fibrillation recurrences, long-term anticoagulation should be guided by the individual stroke risk.

• Literatur

• 1 Camm AJ, Kirchhof P, Lip GY et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369-2429
• 2 Whitlock RP, Healey JS, Connolly SJ. Left atrial appendage occlusion does not eliminate the need for warfarin. Circulation 2009; 120: 1927-1932
• 3 Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857-867
• 4 De Caterina R, Husted S, Wallentin L et al. New Oral Anticoagulants in Atrial Fibrillation and Acute Coronary Syndromes: ESC Working Group on Thrombosis-Task Force on Anticoagulants in Heart Disease Position Paper. J Am Coll Cardiol 2012; 59: 1413-1425
• 5 Berger M, Schweitzer P. Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol 1998; 82: 1545-1547
• 6 Khan IA. Atrial stunning: determinants and cellular mechanisms. Am Heart J 2003; 145: 787-794
• 7 Manning WJ, Silverman DI, Katz SE et al. Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation. J Am Coll Cardiol 1994; 23: 1535-1540
• 8 Nagarakanti R, Ezekowitz MD, Oldgren J et al. Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation 2011; 123: 131-136
• 9 Stellbrink C, Nixdorff U, Hofmann T. ACE (Anticoagulation in Cardioversion using Enoxaparin) Study Group et al. Safety and efficacy of enoxaparin compared with unfractionated heparin and or anticoagulants for prevention of thromboembolic complications in cardioversion of nonvalvular atrial fibrillation: the Anticoagulation in Cardioversion using Enoxaparin (ACE) trial. Circulation 2004; 109: 997-1003
• 10 Israel CW, Grönefeld G, Ehrlich JR et al. Long-term ris of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. J Am Coll Cardiol 2004; 43: 47-52