Prevention of @entity887 after cardioversion of XXXX . Current and evolving strategies.

@entity1 @entity887 @entity1031 @entity956 @entity955 @entity715
We review the incidence of @entity887 following cardioversion of @entity955 , as well as the literature that forms the basis for the current strategy of anticoagulation before, and following, cardioversion to reduce the risk of post-cardioversion @entity887 . We evaluate a new strategy that uses transesophageal echocardiography to identify @entity1 in @entity955 without @entity955 who may be safely cardioverted without preceding anticoagulation and we also address the embolic event and anticoagulation issues in @entity1 with @entity956 . Cardioversion of @entity955 to sinus rhythm is associated with a small but significant risk of @entity1031 events (average incidence, 1.5%; range, 0% to 7%). Anticoagulating these @entity1 before cardioversion appears to significantly reduce this risk, and because of the delay in return of atrial contraction, anticoagulation should be continued for several weeks following cardioversion. The current guidelines for anticoagulating @entity1 in @entity955 who are to be cardioverted is based primarily on clinical observations, numerous uncontrolled case series, two retrospective trials, and one prospective nonrandomized controlled trial. Anticoagulation for 3 weeks before cardioversion followed by 4 weeks of anticoagulation after cardioversion is a theoretically sound and effective approach to reduce the risk of @entity1031 events. The use of transesophageal echocardiography to rule out @entity715 and thus identify low-risk @entity1 who may undergo cardioversion without preceding anticoagulation has been supported by several small studies that successfully used this strategy. However, the demonstration of a postcardioversion atrial and @entity955 "stunning" suggests that anticoagulation needs to be given at the time of, and following, cardioversion. While promising, this transesophageal echocardiography--guided strategy for cardioversion of @entity1 in @entity955 requires more rigorous study before its routine use can be recommended. The current management of pure @entity956 requires no anticoagulation before cardioversion; however, several clinical observation suggest theoretical risks for @entity887 in these @entity1 , thus further investigation of this strategy may be warranted.
