Abstract
In this manuscript, we discuss the most important changes in the field of anticoagulant treatment in patients with atrial fibrillation in the setting of electrical cardioversion or catheter ablation. Moreover, we provide practical guidance as well as information on daily practice.
Highlights
For successful restoration of sinus rhythm in patients with atrial fibrillation (AF), electrical cardioversion (ECV) is a quicker and more effective strategy than pharmacological cardioversion, with the highest success rates in case of pretreatment with antiarrhythmic drugs [1,2,3,4,5]
In addition to a short update of the most important changes, and a review of the non-vitamin K oral anticoagulants (NOACs)-related regimens, we provide some practical guidance and information on daily practice of anticoagulation in the setting of cardioversion in Europe
Whereas for AF of more than 48 hours of duration no important changes have been reported, a stricter regimen has been introduced for anticoagulation therapy prior to ECV in the setting of short duration AF (Fig. 1; [3])
Summary
For successful restoration of sinus rhythm in patients with atrial fibrillation (AF), electrical cardioversion (ECV) is a quicker and more effective strategy than pharmacological cardioversion, with the highest success rates in case of pretreatment with antiarrhythmic drugs [1,2,3,4,5]. For patients in whom cardioversion is performed within 48 hours of AF onset, the recommendations with regard to periprocedural anticoagulation have become less liberal over the years [3, 10]. Preprocedural anticoagulation is recommended for all patients, irrespective of risk factors for stroke. The same holds true for the 4-week postprocedural anticoagulation regimen. These recommendations pertain to both chemical and electrical cardioversion [3]. In addition to a short update of the most important changes, and a review of the NOAC-related regimens, we provide some practical guidance and information on daily practice of anticoagulation in the setting of cardioversion in Europe
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