Electrical Cardioversion Procedure: Risk of Acute Ischemic Stroke in Atrial Fibrillation

Four weeks of anticoagulation therapy after an electrical cardioversion procedure (ECV) in patients with atrial fibrillation (AF) is suggested by current guidelines to reduce the risk of stroke. However, according to a study published in the International Journal of Cardiology, there is a lack of recent data on acute ischemic stroke (AIS) risk and timing after ECV for AF.

As such, Chih-Kang Huang, MD and colleagues from the Tri-Service General Hospital of the National Defense Medical Center in Taipei, Taiwan, analyzed a Taiwanese population and found that patients with AF who underwent an ECV procedure had a higher risk of developing AIS within seven days, but not within 30 days.

The team reviewed data of patients from the National Health Insurance Research Database (NHIRD) in Taiwan. Their final cohort included 5,723 patients with AF who received an ECV procedure and 5,723 propensity score-matched controls. The primary outcome assessed was the cumulative incidence of AIS during the two follow-up periods listed above.

Compared to the controls, patients with AF who received an ECV procedure demonstrated a significantly increased incidence of seven-day AIS development (adjusted hazard ratio [HR] = 1.524; p = 0.003). However, the increase was not significant at day 30 (HR = 1.301; p = 0.426).

Dr. Huang concluded that the apparent drop-off in risk of AIS could be relevant for care, closing with the suggestion that, “the optimal duration of antithrombotic therapy after ECV deserves further investigation.”

What is Electrical Cardioversion?

Cardioversion is a procedure that is used to correct arrhythmias, such as atrial fibrillation and atrial flutter. Compared to chemical cardioversion with medications, an electrical cardioversion procedure typically uses electrodes placed on the chest to send electric shocks to the heart to restore a normal heart rate.