Abstract
Cardiogenic shock patients with atrial fibrillation or flutter often require acute cardioversion despite absence of sufficient anticoagulation or the possibility to rule out left atrial appendage thrombus.
The aim of this study was to analyse thromboembolic risk of acute cardioversion in cardiogenic shock patients.
All cardiogenic shock patients from a registry undergoing electrical cardioversion for atrial fibrillation or atrial flutter were included in this study. The primary endpoint was new thromboembolic stroke or systemic embolism after cardioversion. Secondary endpoints included anticoagulation therapy, use of transesophageal echocardiography, all-cause mortality and bleeding according to BARC criteria.
Of 140 patients undergoing electrical cardioversion, 36 had preexisting and 104 experienced new onset of atrial fibrillation or flutter during ICU stay. Of these, 87.1% had anticoagulation with unfractionated heparin and anticoagulation was adjudicated sufficient in 44.3% at the time of cardioversion. Transesophageal echocardiography was performed in 37.9% of patients before cardioversion. The primary endpoint was met in 3 patients (2.1%). All-cause mortality at 30 days was 37.9% and bleeding after cardioversion ≥ BARC type 3a was found in 12.9% (Figure 1).
Author notes
Funding Acknowledgements: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft.
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