Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.
Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.
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DOI：
10.1056/nejm200105103441901
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发表时间：
2001-05-10
影响因子：
158.5
通讯作者：
Stoddard, MF
中科院分区：
文献类型：
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作者：
Klein, AL;Grimm, RA;Stoddard, MF
背景资料：房颤患者接受电击复律的常规治疗策略是在复律前开华法林抗凝治疗三周。有人提出，如果经食管超声心动图显示没有心房血栓，心脏复律可以进行安全后，只有很短的一段时间的抗凝therapy.Methods：在一个多中心，随机，前瞻性的临床试验，我们招募了1222例房颤的持续时间超过两天，并将他们分配到任何一个治疗的指导下，经食管超声心动图或常规治疗的结果。复合主要终点为8周内的脑血管意外、短暂性脑缺血发作和外周栓塞。次要终点为功能状态、成功恢复和维持窦性心律、出血和死亡。两个治疗组的栓塞事件发生率无显著差异（经皮超声心动图组619例患者中有5例栓塞事件[0.8%]），而常规治疗组603例患者中有3例栓塞事件[0.5%]，P=0.50）。然而，经皮超声心动图组的出血事件发生率显著较低（18起事件[2.9%] vs. 33起事件[5.5%]，P=0.03）。经皮超声心动图组患者的心脏复律时间也较短（平均值[+/-SD]，3.0+/-5.6天vs. 30.6+/-10.6天; P
Background: The conventional treatment strategy for patients with atrial fibrillation who are to undergo electrical cardioversion is to prescribe warfarin for anticoagulation for three weeks before cardioversion. It has been proposed that if transesophageal echocardiography reveals no atrial thrombus, cardioversion may be performed safely after only a short period of anticoagulant therapy.Methods: In a multicenter, randomized, prospective clinical trial, we enrolled 1222 patients with atrial fibrillation of more than two days' duration and assigned them to either treatment guided by the findings on transesophageal echocardiography or conventional treatment. The composite primary end point was cerebrovascular accident, transient ischemic attack, and peripheral embolism within eight weeks. Secondary end points were functional status, successful restoration and maintenance of sinus rhythm, hemorrhage, and death.Results: There was no significant difference between the two treatment groups in the rate of embolic events (five embolic events among 619 patients in the transesophageal-echocardiography group [0.8 percent]) vs. three among 603 patients in the conventional-treatment group [0.5 percent], P=0.50). However, the rate of hemorrhagic events was significantly lower in the transesophageal-echocardiography group (18 events [2.9 percent] vs. 33 events [5.5 percent], P=0.03). Patients in the transesophageal-echocardiography group also had a shorter time to cardioversion (mean [+/-SD], 3.0+/-5.6 vs. 30.6+/-10.6 days; P