Klein H H
Medizinische Klinik II, Schwerpunkt Kardiologie/Pneumologie, Klinikum Idar-Oberstein.
Dtsch Med Wochenschr. 2013 Jun;138(24):1309-11. doi: 10.1055/s-0033-1343211. Epub 2013 Jun 4.
Electrical cardioversions are performed to restore sinus rhythm in patients with non-valvular atrial fibrillation to improve symptoms. It has been known for decades that cardioversion without adequate anticoagulation for 3-4 weeks prior to and for 4 weeks after cardioversion results in thromboembolic complication of about 5%. It is much less known that cardioversion is also associated with a higher risk of thromboembolism (stroke, peripheral embolism) in patients treated with usual anticoagulation. The control arms (warfarin) of the three studies with the new anticoagulants dabigatran, rivaroxaban, and apixaban for the prevention of thromboembolism in non-valvular atrial fibrillation report a monthly thromboembolic risk of 0,13-0,2%. The risk for thromboembolic complication in the month following cardioversion is about three to six times higher than without cardioversion in patients with non-valvular atrial fibrillation treated with usual anticoagulation. Since most cardioversions are performed by DC shock it is not known whether electrical and pharmacological cardioversions carry the same risk for thromboembolism. Although thromboembolic complications do not often occur following cardioversion the increased risk due to this procedure should be acknowledged. Strict anticoagulation (e. g. INR value > 2,5) in the first 10-14 days following cardioversion could possibly minimize the risk of thromboembolism.
进行电复律是为了使非瓣膜性心房颤动患者恢复窦性心律以改善症状。几十年来人们已经知道，在复律前3 - 4周以及复律后4周内未进行充分抗凝的情况下进行复律，会导致约5%的血栓栓塞并发症。而鲜为人知的是，在接受常规抗凝治疗的患者中，复律也与较高的血栓栓塞（中风、外周栓塞）风险相关。三项使用新型抗凝剂达比加群、利伐沙班和阿哌沙班预防非瓣膜性心房颤动血栓栓塞的研究中的对照组（华法林组）报告的每月血栓栓塞风险为0.13 - 0.2%。在接受常规抗凝治疗的非瓣膜性心房颤动患者中，复律后当月发生血栓栓塞并发症的风险比未进行复律者高出约三至六倍。由于大多数复律是通过直流电电击进行的，尚不清楚电复律和药物复律是否具有相同的血栓栓塞风险。尽管复律后血栓栓塞并发症并不常发生，但应认识到该操作会增加风险。复律后的前10 - 14天进行严格抗凝（例如国际标准化比值＞2.5）可能会将血栓栓塞风险降至最低。
