Abstract
Atrial fibrillation the most common cardiac arrhythmia. Its incidence rises steadily with each decade, becoming a real “epidemic phenomenon”. Cardioversion is defined as a rhythm control strategy which, if successful, restores normal sinus rhythm. This, whether obtained with synchronized shock or with drugs, involves a periprocedural risk of stroke and systemic embolism which is reduced by adequate anticoagulant therapy in the weeks before or by the exclusion of left atrial thrombi. Direct oral anticoagulants are safe, manageable, and provide rapid onset of oral anticoagulation; they are an important alternative to heparin/warfarin from all points of view, with a considerable reduction in bleedings and increase in the safety and quality of life of patients.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide
Recent important studies on direct oral anticoagulant (DOAC) have been considered by the American Heart Association (AHA), American College of Cardiology suggest new possibilities in cardioversion and deserve to be examined [13,14,19]
Warfarin has been the primary oral anticoagulant used for patients with AF [34], affirming its superiority over acetylsalicylic acid in reducing thromboembolic risk [1,11,12,13]
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. It is nowadays a real “epidemic phenomenon” considering an incidence of approximately 25% in patients aged >40 years with high prevalence in elderly patients [1,2,3,4,5,6]. Sinus rhythm restoration, either obtained with electrical cardioversion or with drugs, carries a periprocedural risk of stroke and systemic embolism which is decreased by adequate anticoagulation in the weeks before cardioversion or excluding left atrial thrombi before the procedure [1,9,10,11,12,13,14] (see Figure 1) For these reasons, prophylactic anticoagulation represents a cornerstone of peri-cardioversion management in patients with AF [1,2,3,4,5,6,7,8,9,10,11,12], even if, in patients with datable AF (less than 48 h), it is usual to perform cardioversion without transesophageal echocardiogram (TEE) or antecedent oral anticoagulant therapy (OAT) [12,13,14].
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