Bernhardt Peter, Schmidt Harald, Hammerstingl Christoph, Lüderitz Berndt, Omran Heyder
Department of Medicine-Cardiology, University of Bonn, Bonn, Germany.
J Am Soc Echocardiogr. 2005 Jun;18(6):649-53. doi: 10.1016/j.echo.2004.09.022.
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.
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.
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.
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.
心房颤动复律后发生脑栓塞的风险增加。对于口服抗凝治疗下经食管超声心动图（TEE）引导复律的患者，脑栓塞的发生率知之甚少。
连续纳入心房颤动且接受TEE引导复律的患者进行研究。在复律前后4周内，我们进行了系列TEE检查、动态心电图检查、头颅磁共振成像及临床检查。所有患者均继续或开始口服抗凝治疗。
在观察期内，127例患者中有6例（4.7%）在复律后经头颅磁共振成像证实出现新的栓塞病灶。发生事件的患者比未发生事件的患者年龄显著更大（P = 0.04），左心房更大（P = 0.04）。
心房颤动且接受口服抗凝治疗的患者在TEE及抗凝引导下复律后，临床明显脑栓塞的发生率较低。无症状脑栓塞的发生率约为5%。年龄和左心房大小是事件发生的预测因素。
