Tuesday, May 19, 2020

High-yield : Risk of stroke with cardioversion


Electrical/chemical cardioversion performed in a case of atrial fibrillation may carry a high-risk of stroke, especially if >48 hours of time has passed (thrombus formation takes about 48 hours).

If the symptoms of atrial fibrillation started showing less than 48 hours ago, cardioversion is probably safe to perform. But if it is delayed, it is advised to give anti-coagulant therapy to the patient for about 3 weeks before performing cardioversion procedure. Trans-esophageal echocardiogram may be performed to exclude thrombus formation for clearing doubt, if any.

However there's an exception:
In case the patient is going into a state of hypotensive crisis/shock, it is an emergency situation, and cardioversion is to be performed on emergent basis, irrespective of the thromboembolic consequences.

Note: Anticoagulation therapy must always be given to the patient of atrial fibrillation, even if the sinus rhythm is restored and rate is controlled. There is always some risk of stroke in such patients. Calculate the stroke risk by CHADS VASC score - if score is >2, give warfarin or other anticoagulant. If the score is 0-1, give aspirin. (Aspirin is usually the less effective anticoagulant in prevention of stroke in such patients, with however lesser risk of bleeding).

Hope you keep this in mind next time you see a case of AFib.
That's all!
- Jaskunwar Singh

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