Cardioversion guided by transesophageal echocardiography: The ACUTE pilot study - A randomized, controlled trial

被引:162
作者
Klein, AL
Grimm, RA
Black, IW
Leung, DY
Chung, MK
Vaughn, SE
Murray, RD
Miller, DP
Arheart, KL
机构
[1] UNIV NEBRASKA, OMAHA, NE USA
[2] RIVERSIDE METHODIST HOSP, COLUMBUS, OH 43214 USA
[3] OHIO STATE UNIV, COLUMBUS, OH 43210 USA
[4] UNIV CALIF SAN FRANCISCO, MED CTR, SAN FRANCISCO, CA 94143 USA
[5] UNIV LOUISVILLE, LOUISVILLE, KY 40292 USA
[6] TEXAS HEART INST, HOUSTON, TX 77025 USA
[7] PRINCE HENRY HOSP, SYDNEY, NSW, AUSTRALIA
[8] BRONX VET AFFAIRS MED CTR, BRONX, NY USA
[9] UNIV ESSEN GESAMTHSCH, ESSEN, GERMANY
关键词
electric countershock; atrial fibrillation; echocardiography; transesophageal; thromboembolism; anticoagulants;
D O I
10.7326/0003-4819-126-3-199702010-00004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Electrical cardioversion in patients with atrial fibrillation is associated with an increased risk for embolic stroke. Screening for atrial thrombi with transesophageal echocardiography (TEE) before cardioversion should, in many patients, safely permit cardioversion to be done earlier than would be possible with prolonged conventional, anticoagulation therapy. Objective: To compare the feasibility and safety of TEE-guided early cardioversion with those of conventional management of cardioversion in patients with atrial fibrillation. Design: Randomized, multicenter clinical trial. Setting: 10 hospitals in the United States, Europe, and Australia. Patients: 126 patients who had atrial fibrillation lasting longer than 2 days and were having electrical cardioversion. Intervention: Conventional therapy or early, TEE-guided cardioversion with short-term anticoagulation therapy. Outcome Measures: Feasibility outcome variables were frequency of cardioversion and times to cardioversion and sinus rhythm. Safety outcomes were ischemic stroke, transient ischemic attack, systemic embolization, bleeding, and detected episodes of clinical hemodynamic instability occurring as long as 4 weeks after cardioversion. Results: 62 patients were randomly assigned to receive TEE-guided cardioversion; IEE was done in 56 (90%) of these patients. Atrial thrombi were detected in 7 patients (13%) and led to the postponement of cardioversion. Cardioversion was successful in 38 of 45 patients (84%) who had early cardioversion. No embolization occurred with this strategy. Of the 64 patients receiving conventional therapy, 37 (58%) had cardioversion, which was successful in 28 patients (76%). One patient had a peripheral embolic event. The time to cardioversion was shorter in the TEE group (0.6 weeks [95% Cl, 0.3 to 0.9 weeks] compared with 4.8 weeks [Cl, 3.8 to 5.7 weeks]; P < 0.01). The incidence of clinical hemodynamic instability and bleeding complications tended to be greater in the conventional therapy group. Conclusions: These results suggest that TEE-guided cardioversion with short-term anticoagulation therapy is feasible and safe. The use of TEE may allow cardioversion to be done earlier, may decrease the risk for embolism associated with cardioversion, and may be associated with less clinical instability than conventional therapy. A large multicenter study to confirm these findings is currently under way.
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页码:200 / +
页数:1
相关论文
共 57 条
[1]  
ABERG H, 1968, ACTA MED SCAND, V183, P415
[2]  
ALPERT JS, 1988, ANNU REV MED, V39, P41, DOI 10.1146/annurev.me.39.020188.000353
[3]   ROLE OF PROPHYLACTIC ANTICOAGULATION FOR DIRECT-CURRENT CARDIOVERSION IN PATIENTS WITH ATRIAL-FIBRILLATION OR ATRIAL-FLUTTER [J].
ARNOLD, AZ ;
MICK, MJ ;
MAZUREK, RP ;
LOOP, FD ;
TROHMAN, RG .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 19 (04) :851-855
[4]   TRANSESOPHAGEAL TWO-DIMENSIONAL ECHOCARDIOGRAPHY FOR THE DETECTION OF LEFT ATRIAL APPENDAGE THROMBUS [J].
ASCHENBERG, W ;
SCHLUTER, M ;
KREMER, P ;
SCHRODER, E ;
SIGLOW, V ;
BLEIFELD, W .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 7 (01) :163-166
[5]  
Balslov J T, 1968, Nord Med, V79, P243
[6]   SMOKE-LIKE ECHO IN THE LEFT ATRIAL CAVITY IN MITRAL-VALVE DISEASE - ITS FEATURES AND SIGNIFICANCE [J].
BEPPU, S ;
NIMURA, Y ;
SAKAKIBARA, H ;
NAGATA, S ;
PARK, YD ;
IZUMI, S ;
UEOKA, M ;
MASUDA, Y ;
NAKASONE, I .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1985, 6 (04) :744-749
[7]   EFFICACY OF ANTICOAGULANT THERAPY IN PREVENTING EMBOLISM RELATED TO DC ELECTRICAL CONVERSION OF ATRIAL FIBRILLATION [J].
BJERKELUND, CJ ;
ORNING, OM .
AMERICAN JOURNAL OF CARDIOLOGY, 1969, 23 (02) :208-+
[8]   EXCLUSION OF ATRIAL THROMBUS BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY DOES NOT PRECLUDE EMBOLISM AFTER CARDIOVERSION OF ATRIAL-FIBRILLATION - A MULTICENTER STUDY [J].
BLACK, IW ;
FATKIN, D ;
SAGAR, KB ;
KHANDHERIA, BK ;
LEUNG, DY ;
GALLOWAY, JM ;
FENELEY, MP ;
WALSH, WF ;
GRIMM, RA ;
STOLLBERGER, C ;
VERHORST, PMJ ;
KLEIN, AL .
CIRCULATION, 1994, 89 (06) :2509-2513
[9]  
BLACK IW, 1991, BRIT HEART J, V66, P302
[10]  
CHAN M, 1992, J AM SOC ECHOCARDIOG, V5, P308