Incidence of cerebral embolism after cardioversion of atrial fibrillation: a prospective study with transesophageal echocardiography and cerebral magnetic resonance imaging.

BACKGROUND

After cardioversion of atrial fibrillation the risk for cerebral embolism is increased. There is little knowledge about the incidence of cerebral embolism for patients with transesophageal echocardiography (TEE)-guided cardioversion under oral anticoagulation.

METHODS

Consecutive patients with atrial fibrillation and TEE-guided cardioversion were included in the study. We performed serial TEE studies, Holter electrocardiography, cranial magnetic resonance imaging, and clinical examinations during a period of 4 weeks before and after cardioversion. Oral anticoagulation was continued or initiated in all patients.

RESULTS

During the observation period 6 of 127 (4.7%) patients had new embolic lesions after cardioversion documented on cerebral magnetic resonance imaging. Patients with an event were significantly older (P = .04) and had a larger left atrium (P = .04) than patients without event.

CONCLUSION

Patients with atrial fibrillation and oral anticoagulation have a low rate of clinical apparent cerebral embolism after TEE and anticoagulation-guided cardioversion. The rate of silent cerebral embolism is almost 5%. Age and left atrial size are predictors for an event.