European Heart Journal Advance Access originally published online on November 10, 2006
European Heart Journal 2006 27(23):2858-2865; doi:10.1093/eurheartj/ehl353
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The use of enoxaparin compared with unfractionated heparin for short-term antithrombotic therapy in atrial fibrillation patients undergoing transoesophageal echocardiography-guided cardioversion: Assessment of Cardioversion Using Transoesophageal Echocardiography (ACUTE) II randomized multicentre study
1 University of Pittsburgh Medical Center, Scalfe Hall S-563, 200 Lothrop Street, Pittsburgh, PA 15213
2 Mayo Clinic, Gonda 6-411, 200 First Street SW, Rochester, MN 55905
3 Division of Cardiology Room S3-855, UMASS Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655
4 Division of Cardiology, ACB 3rd Floor, 550 South Jackson Street, University of Louisville, Louisville, KY 40292
Received 10 August 2006; revised 29 September 2006; accepted 10 November 2006; online publish-ahead-of-print 10 November 2006.
* Corresponding author: Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue-Desk F15, Cleveland, OH 44195, USA. Tel: +1 216 444 3932; fax: +1 216 445 2309. E-mail address: kleina{at}ccf.org
See page 2742 for the editorial comment on this article (doi:10.1093/eurheartj/ehl350)
Aims To compare the feasibility and safety of transoesophageal echocardiograpy-guided cardioversion (CV) with enoxaparin and unfractionated heparin (UFH) in patients with atrial fibrillation (AF).
Methods and results The Assessment of Cardioversion Using Transoesophageal Echocardiography (ACUTE) II pilot trial compared the safety and efficacy of enoxaparin with UFH in 155 patients with AF who were scheduled for transoesophageal echocardiography (TEE)-guided CV. Safety outcomes over a 5-week period were ischaemic stroke, major or minor bleeding, and death. Efficacy outcomes were length of stay (LOS) and return to normal sinus rhythm (NSR). Of the 76 patients assigned to the enoxaparin group, 72 (94.7%) had a transoesophageal echocardiogram and 63 (82.9%) had early CV, of which 59 (93.7%) were successful. Of the 79 UFH patients, 66 (83.5%) had a transoesophageal echocardiogram and 58 (73.4%) had early CV, of which 54 (98.2%) were successful. There were no significant differences in embolic events, bleeding, or deaths between groups. The enoxaparin group had shorter median LOS compared with the UFH group [3(2–4) vs. 4(3–5)] days; P<0.0001). There was also more NSR at 5 weeks in the enoxaparin group (76 vs. 57%; P=0.013).
Conclusion In the ACUTE II trial, there were no differences in safety outcomes between the two strategies. However, the enoxaparin group had a shorter LOS. Thus, the TEE-guided enoxaparin strategy may be considered a safe and effective alternative strategy for AF. The shorter LOS may translate to lower costs using the enoxaparin TEE-guided approach.
Key Words: Atrial fibrillation • Cardioversion • Enoxaparin • Transoesophageal echocardiography
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