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European Heart Journal 1994 15(9):1279-1280;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Embolic stroke after unanticoagulated cardioversion despite prior exclusion of atrial thrombi by transoesophageal echocardiography

L. MlSSAULT, L. JORDAENS, P. GHEERAERT, L. ADANG and D. CLEMENT

Department of Cardiology, University Hospital De Pintelaan 185, B-9000 Gent, Belgium

Received 18 October 1994; revised 25 April 1994; .

Correspondence L. Missault, MD, Department of Cardiology, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.

Abstract

Recent studies in patients with atrial fibrillation, not on anticoagulation, suggest that if transoesophageal echocardiography (TEE) excludes the presence of thrombi, early cardioversion can be performed safely without the need for anticoagulation before the procedure[1]. Immediately after successful cardioversion, however, left atrium or left atrial appendage stunning may be present, potentially carrying a risk for de novo thrombus formation[2 3]. Furthermore, the presence of spontaneous contrast is considered as a contraindication for unanticoagulated cardioversion since it has been associated with postcardioversion thromboembolism[4]K We present a case in which stroke developed in relation to unanticoagulated cardioversion regardless of careful prior evaluation with TEE.

Key Words: Atrial fibrillation • cardioversion • transoesophageal echocardiography • stroke • anticoagulation


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