Original Article
Use of Transesophageal Echocardiography to Guide Cardioversion in Patients with Atrial Fibrillation
N Engl J Med 2001; 344:1411-1420May 10, 2001
- Abstract
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<0.001) and a greater rate of successful restoration of sinus rhythm (440 patients [71.1 percent] vs. 393 patients [65.2 percent], P=0.03). At eight weeks, there were no significant differences between the two groups in the rates of death or maintenance of sinus rhythm or in functional status.
Conclusions
The use of transesophageal echocardiography to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned.
Media in This Article
Figure 1
The Study Protocol.Figure 2
Treatment Outcomes.Article Activity
- Article
Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice, with an overall prevalence of 0.4 percent in the general population1-4; it affects 2.2 million people in the United States.3,5 Electrical cardioversion is often used to restore sinus rhythm in patients with atrial fibrillation, but the procedure is associated with an increased risk of stroke, which may result if left atrial thrombi are dislodged when sinus rhythm is restored.6-9 The conventional strategy for anticoagulation in patients with atrial fibrillation of prolonged duration (longer than two days) calls for three weeks of empirical anticoagulant treatment before cardioversion, followed by four weeks of warfarin therapy after cardioversion.10 Although anticoagulation before cardioversion has been shown to lower the risk of embolism, the conventional strategy for anticoagulation has never been properly evaluated in a large clinical trial.9 On the other hand, transesophageal echocardiography allows thrombi in the left atrial appendage to be detected with a high degree of accuracy11-13 and has been proposed as a safe means of expediting cardioversion with short-term anticoagulant therapy.9,14-18 There remains controversy concerning which strategy should be used,16,19 but there have been no randomized clinical trials to determine relative efficacy. Therefore, the objective of the Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) Multicenter Study was to compare a conventional anticoagulation strategy with the strategy of using transesophageal echocardiography to guide short-term anticoagulant therapy in patients with atrial fibrillation of more than two days' duration for whom electrical cardioversion is prescribed.
Methods
Study Design
We conducted a controlled, investigator-initiated, prospective, randomized, multicenter trial that compared the clinical outcomes of two distinct treatment strategies in patients with atrial fibrillation for whom electrical cardioversion was prescribed. The study design has been described previously,20 and the protocol is diagrammed in Figure 1Figure 1
The Study Protocol..Patients were enrolled and randomly assigned to either a strategy of treatment guided by the findings on transesophageal echocardiography, with brief anticoagulant therapy, or a conventional treatment strategy following current guidelines.10 Patients assigned to the transesophageal-echocardiography group were given anticoagulant therapy at their initial visit with the intention that they would receive therapeutic anticoagulation at the time of cardioversion and for four weeks thereafter. Inpatients were typically treated with intravenous unfractionated heparin (target activated partial-thromboplastin time, 1.5 to 2.5 times the control value), and the transesophageal echocardiography and subsequent cardioversion were scheduled to be performed within 24 hours. Outpatients received warfarin (target international normalized ratio, 2.0 to 3.0), and transesophageal echocardiography and subsequent cardioversion were scheduled for five days later. The anticoagulation status of all patients undergoing cardioversion was checked immediately before cardioversion.20 With the use of transesophageal echocardiography, the patients were stratified according to the presence or absence of thrombus. Patients assigned to the conventional-treatment group were given warfarin at their initial visit and for three weeks thereafter for therapeutic anticoagulation before cardioversion, followed by a four-week period of warfarin therapy after cardioversion. For both groups, the eight-week study period began at the time of enrollment and lasted until day 56. The study was approved by the institutional review board at each site, and written informed consent was obtained from all patients.
Patients
Patients who were candidates for electrical cardioversion were eligible for enrollment in the study if they were at least 18 years old and had atrial fibrillation of more than two days' duration. Patients with atrial flutter who had a documented history of atrial fibrillation were also eligible. Patients with atrial flutter and no history of atrial fibrillation and patients with hemodynamic instability were excluded from the study. Also excluded were patients receiving long-term warfarin therapy (of more than seven days' duration), patients with contraindications to warfarin or transesophageal echocardiography, women of childbearing potential, and patients who might need procedures requiring the discontinuation of anticoagulation. Patients who were taking antiarrhythmic medication were not excluded from the study, but the commencement of antiarrhythmic therapy was permitted only after a therapeutic level of anticoagulation was achieved.
Outcomes
The primary outcome was a composite of cerebrovascular accident, transient ischemic attack, and peripheral embolism. Secondary clinical outcomes were major and minor hemorrhagic events, death from any cause and from cardiac causes, successful return to and maintenance of sinus rhythm, and functional status as assessed by the Duke Activity Status Index.21,22 Serious adverse events (embolism, hemorrhage, and death) were adjudicated by a central and independent events-review committee, the members of which were blinded to the treatment-strategy assignment. A hemorrhagic complication was considered major if it was fatal, necessitated transfusion, or could not be terminated without a surgical procedure. A central echocardiography laboratory was used to ensure the quality of the echocardiographic data and adherence to the protocol. Protocol violations were recorded and categorized as major or minor on the basis of predefined criteria. A secondary outcome was the relative costs of the two treatment strategies over the eight-week follow-up period.20,23
Statistical Analysis
On the basis of previously reported rates of embolism,20 we used an estimated sample size of 3000 patients to achieve a statistical power of 92 percent with an alpha level of 0.05 for the analysis of the primary end point of all embolic events. The estimate of sample size was based on anticipated rates of embolism of 1.2 percent in the transesophageal-echocardiography group and 2.9 percent in the conventional-treatment group over the eight-week period. The study was designed to include two interim analyses and a final analysis.20
Chi-square tests were conducted for the comparison of categorical variables in the treatment groups. An analysis of variance was used for the comparison of continuous variables. Data are expressed as means ±SD, as medians with interquartile ranges, or as frequencies and percentages with 95 percent confidence intervals. All analyses were based on the intention-to-treat principle. All statistical testing was conducted at a significance level of 0.05 with a two-tailed alternative hypothesis.
The first patient was enrolled on August 6, 1994. A scheduled interim analysis of the first 1000 patients by the data safety and monitoring board was performed on June 15, 1999, and indicated that the rates of both recruitment and events were too low to achieve sufficient statistical power to detect differences between groups in the primary end point. Enrollment was terminated on August 18, 1999, with a total of 1222 patients. After collection and entry of the follow-up data, the study was completed on February 18, 2000.
Results
Base-Line Characteristics
A total of 1222 patients from 70 clinical sites were randomly assigned to either treatment guided by the findings on transesophageal echocardiography (619 patients) or conventional treatment (603 patients). There were no significant differences between the two groups in the base-line clinical and echocardiographic characteristics (Table 1Table 1
Clinical and Echocardiographic Characteristics at Enrollment and Use of Anticoagulant and Antiarrhythmic Agents at the Time of Direct-Current Cardioversion in Patients in the Transesophageal-Echocardiography and Conventional-Treatment Groups.). Most of the patients in both groups had atrial fibrillation rather than atrial flutter, and the median estimated duration of the arrhythmia was 13 days in both groups.Outcomes after Treatment Assignment
The anticoagulation and antiarrhythmic status of the patients in the two treatment groups is shown in Table 1. There were significantly more patients in the transesophageal-echocardiography group who were treated as inpatients with intravenous heparin, but patients in the conventional-treatment group were more likely to receive a bolus of heparin before cardioversion and to have shorter durations of heparin therapy to augment subtherapeutic levels of anticoagulation that had been achieved at the time of cardioversion.
Figure 2Figure 2
Treatment Outcomes. shows the treatment outcomes. Of the 619 patients assigned to the transesophageal-echocardiography group, 425 (68.7 percent) had early electrical cardioversion at a mean of 3.0±5.6 days, and in 344 of these (80.9 percent) the cardioversion was successful. Among the 124 patients who had transesophageal echocardiography but no early electrical cardioversion (20.0 percent), cardioversion was postponed in 76 (61.3 percent) because of thrombi. Of the 603 patients in the conventional-treatment group, 333 (55.2 percent) underwent electrical cardioversion at a mean of 30.6±10.6 days, and in 266 of these (79.9 percent) the cardioversion was immediately successful. Of the 270 who did not undergo electrical cardioversion (44.8 percent), 127 (47.0 percent) had a spontaneous or chemical conversion. The remaining 143 (53.0 percent) did not undergo cardioversion for various reasons. Thirty-two patients in the conventional-treatment group underwent transesophageal echocardiography during the study period.An important difference in outcome between treatments was the time to cardioversion, which was much shorter with the approach guided by transesophageal echocardiography (3.0±5.6 days, vs. 30.6±10.6 days with conventional treatment; P<0.001). The ability to attempt cardioversion earlier with the use of transesophageal echocardiography also resulted in the use of direct-current cardioversion in a higher proportion of patients than did the conventional strategy (461 of 619 patients [74.5 percent] vs. 333 of 603 patients [55.2 percent], P<0.001).
Embolic Events
Table 2Table 2
Clinical Outcomes at Eight Weeks among Patients with Atrial Fibrillation of More Than Two Days' Duration in the Transesophageal-Echocardiography Group and the Conventional-Treatment Group. shows the clinical outcomes, including the composite primary end point of cerebrovascular accidents, transient ischemic attacks, or peripheral embolism, for both groups. In this study, the total number of embolic events was low, and there was no statistically significant difference between the two treatment groups in the rate of such events (five events in the transesophageal-echocardiography group [0.8 percent; 95 percent confidence interval, 0 to 1.5 percent] vs. three events in the conventional-treatment group [0.5 percent; 95 percent confidence interval, 0 to 1.1 percent], P=0.50). A summary of the embolic events in the patients is provided in Table 3Table 3
Summary of Adjudicated Embolic Events during the Eight-Week Study Period in the Transesophageal-Echocardiography Group and the Conventional-Treatment Group.. The mean age of patients with embolic events was 67±7 years, and seven of the eight patients with such events (87.5 percent) had risk factors for stroke at enrollment.Thrombus Revealed by Transesophageal Echocardiography
A total of 76 patients (13.8 percent) with right or left heart thrombi were identified among the 549 patients who underwent a transesophageal echocardiographic examination. Of these 76 patients with thrombi, 67 (88.2 percent) had a thrombus in the left atrial appendage. None of the patients with thrombi had an embolic event during the eight-week study, although four of these patients died from various causes and two others had major hemorrhagic complications. In subgroup analyses, there were no significant differences between the patients with a thrombus and those without a thrombus in the rates of embolism, hemorrhage, or death.
Hemorrhagic Events
The rates of major and minor hemorrhagic events are shown in Table 2. In the transesophageal-echocardiography group, there were 5 major and 14 minor hemorrhagic complications in a total of 18 patients. In contrast, in the conventional-treatment group there were 9 major and 24 minor hemorrhagic complications in 33 patients. The combined rate of major and minor hemorrhagic events was significantly lower in the transesophageal-echocardiography group than in the conventional-treatment group (2.9 percent [95 percent confidence interval, 1.6 to 4.2 percent] vs. 5.5 percent [95 percent confidence interval, 3.7 to 7.3 percent], P=0.03). A summary of the major hemorrhagic events in these patients is provided in Table 4Table 4
Summary of Major Bleeding Events and Deaths as Secondary End Points during the Eight-Week Study Period in the Transesophageal-Echocardiography and Conventional-Treatment Groups.. The mean age of patients with a major hemorrhage was 73±8 years. The most common site of major hemorrhage was the gastrointestinal tract.Deaths
Table 2 includes the secondary end points of death from all causes, deaths from cardiac causes, and deaths from noncardiac causes in the two treatment groups. There was no statistically significant difference between the two groups in the rate of death from cardiac causes and the rate of death from noncardiac causes, but there was a trend toward a higher rate of death from all causes in the transesophageal-echocardiography group (15 deaths [2.4 percent; 95 percent confidence interval, 1.2 to 3.6 percent] vs. 6 deaths [1.0 percent; 95 percent confidence interval, 0.2 to 1.8 percent], P=0.06). A summary of deaths of patients (adjudicated events) is provided in Table 4. Twenty of the 21 patients who died (95 percent) had coexisting conditions. Only one death (5 percent) resulted from an embolic event.
Sinus Rhythm
The frequency of restoration and maintenance of sinus rhythm at eight weeks in the two treatment groups is shown in Table 2. There was no significant difference between the two groups in the immediate success of electrical cardioversion (370 of 461 attempted cardioversions [80.3 percent; 95 percent confidence interval, 76.6 to 83.9 percent] in the transesophageal-echocardiography group vs. 266 of 333 attempted cardioversions [79.9 percent; 95 percent confidence interval, 75.6 to 84.2 percent] in the conventional-treatment group, P=0.90). However, initial success in restoring sinus rhythm (through electrical, spontaneous, or chemical conversion) was achieved in a significantly higher proportion of patients in the transesophageal-echocardiography group during the eight-week study period (440 patients [71.1 percent; 95 percent confidence interval, 67.5 to 74.7 percent] vs. 393 patients [65.2 percent; 95 percent confidence interval, 61.4 to 68.9 percent], P=0.03). At eight weeks there was no significant difference between the two groups in the proportion of patients in whom normal sinus rhythm had been maintained (52.7 percent [95 percent confidence interval, 46.4 to 54.4 percent] in the transesophageal-echocardiography group vs. 50.4 percent [95 percent confidence interval, 48.7 to 56.6 percent] in the conventional-treatment group, P=0.43) (Table 2). There was, however, greater use of antiarrhythmic medication in the conventional-treatment group at the time of cardioversion (92.8 percent [95 percent confidence interval, 90.0 to 95.5 percent] vs. 82.2 percent [95 percent confidence interval, 78.7 to 85.7 percent], P<0.001) (Table 1).
Atrial Flutter versus Atrial Fibrillation
There were no significant differences between the base-line characteristics or the embolic or hemorrhagic outcomes of patients with atrial flutter and a history of atrial fibrillation and those of patients with atrial fibrillation. There were also no significant differences between the two treatment groups in the proportion of patients with atrial flutter. However, as a subgroup, the 58 patients with atrial flutter (4.7 percent of the total study cohort) had a significantly higher rate of initial success of cardioversion than did the patients with atrial fibrillation (39 of 41 attempted cardioversions [95.1 percent] vs. 593 of 753 attempted cardioversions [78.8 percent], P=0.01), as well as a higher rate of maintenance of sinus rhythm at eight weeks (41 of 53 patients with complete follow-up data [77.4 percent] vs. 584 of 1054 [55.4 percent], P=0.002).
Functional Capacity
Table 1 shows the base-line functional status as assessed by the Duke Activity Status Index: mean (±SD) scores of 28.2±17.4 for the patients in the transesophageal-echocardiography group and 27.9±17.8 for those in the conventional-treatment group. At eight weeks, the mean Duke Activity Status Index Score was 27.4±18.3 in the transesophageal-echocardiography group and 26.7±18.6 in the conventional-treatment group (Table 2). These data indicate that there was no significant difference in either treatment group between the functional status of the patients at base line and that at eight weeks, and there was no significant difference between the two groups in functional status at eight weeks.
Discussion
We found that during the eight weeks of the study, there was no significant difference between the two treatment groups in the rate of embolic events. However, the strategy of treatment guided by transesophageal echocardiography did allow for early, safe electrical cardioversion and resulted in fewer total hemor-rhagic events than the conventional treatment strategy.
The three-week period of therapeutic anticoagulation required before cardioversion is a drawback of the conventional treatment strategy.16,24 The interval between enrollment and electrical cardioversion was much shorter in the transesophageal-echocardiography group than in the conventional-treatment group (3 days vs. 31 days). The longer duration of anticoagulant therapy before cardioversion with the conventional treatment strategy resulted in a larger number of spontaneous conversions but also in greater difficulty in maintaining anticoagulation at therapeutic levels and more scheduling difficulties and refusals by patients to undergo electrical cardioversion (Figure 2).
The rate of embolism in the trial was much lower in both treatment groups than had been anticipated20 (0.7 percent overall), and there was no significant difference between the groups in the rate of cerebrovascular events. This study demonstrates that both treatment strategies are successful in maintaining low rates of embolism when guidelines are followed carefully. In particular, it demonstrates the importance of maintaining therapeutic anticoagulation in the period after cardioversion even if there is no evidence of thrombus on transesophageal echocardiography.25,26
The conventional strategy for anticoagulation, as outlined by the American College of Chest Physicians,10 has not been carefully studied in clinical trials. Furthermore, in clinical practice, conventional guidelines for anticoagulation are not routinely followed in as many as 40 percent of the patients undergoing cardioversion, particularly elderly patients.27,28 In the transesophageal-echocardiography group, prolonged anticoagulant therapy was limited to the 76 patients with thrombi, which were detected most often in the left atrial appendage. The rate of detection of thrombus in our study, 13.8 percent, is consistent with the rates of 9 to 15 percent reported previously.14,16,18
The aggregate rate of hemorrhage among patients in both treatment groups in this trial was 4.2 percent, which was higher than had been anticipated.20 There were nearly twice as many major and minor hemorrhagic events in the conventional-treatment group as in the transesophageal-echocardiography group over the eight-week period. The fact that the hemorrhagic events in our study were predominantly minor is in accordance with the results of other studies.16,24,29 The difference between the treatment groups in the rates of hemorrhagic events is not surprising, since the duration of anticoagulant therapy required by the conventional strategy is almost double that with the other approach and thus allows more opportunity for bleeding.10,16,29,30
There was a trend toward a higher rate of death from any cause in the transesophageal-echocardiography group. However, there was no significant difference between the groups in the rate of death from cardiac causes. Ninety-five percent of the patients in both groups who died had serious coexisting conditions. On the basis of experimental studies of atrial fibrillation,31,32 some investigators have postulated that the strategy of treatment guided by transesophageal echocardiography may improve the ability to restore and maintain sinus rhythm with earlier cardioversion and after a shorter duration of atrial fibrillation.20,33 There was a greater overall rate of success in achieving sinus rhythm in the transesophageal-echocardiography group, but at eight weeks there was no significant difference between the groups in the maintenance of sinus rhythm. It is not known whether the greater use of antiarrhythmic medication in the conventional-treatment group had an effect on the relative rates of maintenance of sinus rhythm.
Several studies in the 1990s suggested that the strategy of using transesophageal echocardiography to guide anticoagulant therapy for atrial fibrillation might be both feasible and safe. In more than 1300 patients previously studied by North American and European investigators, there was only 1 documented embolic event in cases involving treatment guided by transesophageal echocardiography with short-term anticoagulant therapy.14-16,18,34,35
Both treatment strategies in our study resulted in low rates of embolism. The strategy of treatment guided by transesophageal echocardiography was associated with an overall reduction in the time to cardioversion and in the total rate of hemorrhagic complications, as compared with the conventional treatment strategy. Thus, the strategy of using transesophageal echocardiography to guide treatment may be considered a safe and clinically effective alternative to the conventional treatment strategy.
Supported in part by grant-in-aid awards from the American Medical Association Educational and Research Foundation, the American Society of Echocardiography, and Advanced Technology Laboratories.
We are indebted to Susan E. Jasper, B.S.N., senior clinical coordinator, Ariel Goodman-Bizon, B.A., research coordinator, Elizabeth A. Lieber, B.A., programmer, and Kristopher L. Arheart, Ed.D., senior statistician, for their dedicated efforts.
Source Information
From the Cleveland Clinic Foundation, Cleveland (A.L.K., R.A.G., R.D.M., C.A.-H.); Hennepin County Medical Center, Minneapolis (R.W.A.); Manly Hospital, Manly, N.S.W., Australia (I.W.B.); Boston Medical Center, Boston (R.D.); Universitätsklinikum–Essen, Essen, Germany (R.E.); Mount Sinai School of Medicine, New York (J.L.H.); Ohio State University, Columbus (D.A.O.); the University of Nebraska, Omaha (T.R.P.); and the University of Louisville, Louisville, Ky. (M.F.S.).
Address reprint requests to Dr. Klein at the Cleveland Clinic Foundation, 9500 Euclid Ave., Department of Cardiology — Desk F15, Cleveland, OH 44195, or at kleina@ccf.org.
The study investigators are listed in the Appendix.
Appendix
The following centers and investigators participated in the trial (the number of patients enrolled at each center is given in parentheses): University of Louisville (110) — M. Stoddard; Cleveland Clinic Foundation (104) — A. Klein; Centro Medico de Caracas (53) — H. Acquatella; Winthrop–University Hospital (51) — R. Smith; University of Nebraska (50) — T. Porter; Escorts Heart Institute and Research Centre (50) — N. Trehan; Lancaster Heart Foundation (44) — R. Small; Paulista School of Medicine (44) — W. Mathias, Jr.; Universitätsklinikum–Essen (37) — R. Erbel; University of Pittsburgh Medical Center (29) — W. Katz; Vera Cruz and Socor Hospitals (28) — M. Barbosa; St. Elizabeth Hospital Tilburg (25) — P. Melman, H. Pasteuning; El-Azhar University (25) — M. Madkour; University of Massachusetts (24) — L. Pape; Instituto Cardiovascular de Rosario (24) — E. Tuero; Ospedale Civile (21) — D. Mele; University of California, San Diego, Medical Center (19) — D. Blanchard; University of Rochester–Strong Memorial Hospital (18) — J. Eichelberger; Riverside Methodist Hospital (18) — T. Obarski; University of California, San Francisco, Medical Center (17) — R. Redberg; Queen Elizabeth Hospital (17) — S. Li; Heart Group (16) — P. Fattal; New England Medical Center (15) — S. Schwartz; University of Cincinnati (14) — B. Hoit; North Shore University Hospital (14) — S. Rosen; St. Luke's–Roosevelt Hospital (14) — N. Krasnow; Central Minnesota Heart Center (14) — R. Jolkovsky; White River Junction Veterans Affairs Medical Center (14) — M. Garcia; Bronx Veterans Affairs Medical Center (13) — L. Baruch; Medical College of Virginia (13) — J. Arrowood; University of Texas Southwestern Medical Center (13) — P. Grayburn; Harbor–UCLA Medical Center (13) — S. Shapiro; Hospital dos Servidores do Estado (13) — J. Filho, M. Carneiro; MacNeal Center for Clinical Research (13) — J. Briller; St. John's Mercy Medical Center (12) — L. Mezei; University of Chicago Medical Center (11) — R. Lang; Manly Hospital (11) — I. Black; St. Nicholas Hospital (10) — L. Coulis; Loma Linda Veterans Affairs Medical Center (10) — R. Pai; Easton Hospital (10) — K. Khalighi; Green Lane Hospital (10) — S. Greaves; Prince Henry Hospital (10) — W. Walsh; Baylor College of Medicine (9) — M. Quinones; North Central Heart Foundation (9) — D. Nagelhout; Ospedale Generale Valduce (9) — G. Corrado; Texas Heart Institute (8) — S. Wilansky; Royal Victoria Hospital (7) — R. Haichin; Columbia Cardiovascular Clinic (7) — B. Feldman; Austin Heart (7) — G. Rodgers; University of New Mexico (7) — B. Shively; Ohio State University (6) — D. Orsinelli; Medical College of Wisconsin (6) — K. Sagar; Sentara Norfolk General Hospital (6) — G. Nye; Southern New Hampshire Regional Medical Center (6) — S. Schwartz; Ochsner Medical Institutions (6) — F. Abi-Samra; Blodgett Memorial Medical Center (6) — D. Langholz; Clearwater Cardiovascular Consultants (6) — P. Phillips; Hungarian Institute of Cardiology (5) — M. Lengyel; Hartford Hospital (5) — L. Gillam; Allegheny University–Hahnemann Hospital (5) — P. Pollack; Beth Israel Hospital (4) — W. Manning; Boston Medical Center (4) — R. Davidoff; Graduate Hospital (4) — R. Schlesinger; East Carolina University (4) — V. Sorrell; Michigan Capital Medical Center (4) — M. Markarian; Albany Medical College (4) — S. Fein; University of Texas Medical Branch at Galveston (3) — R. Sheahan; Maine Medical Center (2) — M. Cohen; University of Kansas Medical Center (1) — D. Wilson; Northwest Ohio Cardiology (1) — B. DeVries.
Clinical Coordinating Center — A. Klein (principal investigator), R. Grimm, R.D. Murray, D. Leung, M. Garcia, M. Chung. Study Monitoring — S. Jasper, A. Goodman. Data Management — K. Arheart, D. Miller, C. Apperson-Hansen, E. Lieber. Data and Safety Monitoring Board — S. Ellis (chair), P. Elson, J. Olin. Adverse Events Adjudication Committee — A. Furlan, M. Lauer. Economic Analysis Center — Emory University: E. Becker, S. Culler, P. Mauldin. Steering and Publications Committee — A. Klein (chair), C. Apperson-Hansen, R. Asinger, I. Black, R. Davidoff, R. Erbel, R. Grimm, J. Halperin, R.D. Murray, D. Orsinelli, T. Porter, M. Stoddard.
- References
References
1
Prystowsky EN ,Benson DW Jr ,Fuster V , et al. Management of patients with atrial fibrillation: a statement for healthcare professionals: from the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation 1996;93:1262-1277
Web of Science | Medline2
Ostrander LD Jr ,Brandt RL ,Kjelsberg MO ,Epstein FH . Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan. Circulation 1965;31:888-898
Web of Science | Medline3
Feinberg WM ,Blackshear JL ,Laupacis A ,Kronmal R ,Hart RG . Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med 1995;155:469-473
CrossRef | Web of Science | Medline4
Kannel WB ,Abbott RD ,Savage DD ,McNamara PM . Coronary heart disease and atrial fibrillation: the Framingham Study. Am Heart J 1983;106:389-396
CrossRef | Web of Science | Medline5
Blackshear JL ,Kopecky SL ,Litin SC ,Safford RE ,Hammill SC . Management of atrial fibrillation in adults: prevention of thromboembolism and symptomatic treatment. Mayo Clin Proc 1996;71:150-160
CrossRef | Web of Science | Medline6
Lown B . Electrical reversion of cardiac arrhythmias. Br Heart J 1967;29:469-489
CrossRef | Web of Science | Medline7
Bjerkelund CJ ,Orning OM . The efficacy of anticoagulant therapy in preventing embolism related to D.C. electrical conversion of atrial fibrillation. Am J Cardiol 1969;23:208-216
CrossRef | Web of Science | Medline8
Stein B ,Halperin JL ,Fuster V . Should patients with atrial fibrillation be anticoagulated prior to and chronically following cardioversion? Cardiovasc Clin 1990;21:231-247
Medline9
Grimm RA ,Stewart WJ ,Black IW ,Thomas JD ,Klein AL . Should all patients undergo transesophageal echocardiography before electrical cardioversion of atrial fibrillation? J Am Coll Cardiol 1994;23:533-541
CrossRef | Web of Science | Medline10
Laupacis A ,Albers G ,Dalen J ,Dunn MI ,Jacobson AK ,Singer DE . Antithrombotic therapy in atrial fibrillation. Chest 1998;114:Suppl:579S-589S
CrossRef | Web of Science | Medline11
Aschenberg W ,Schluter M ,Kremer P ,Schroder E ,Siglow V ,Bleifeld W . Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus. J Am Coll Cardiol 1986;7:163-166
CrossRef | Web of Science | Medline12
Manning WJ ,Weintraub RM ,Waksmonski CA , et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi: a prospective, intraoperative study. Ann Intern Med 1995;123:817-822
Web of Science | Medline13
Fatkin D ,Scalia G ,Jacobs N , et al. Accuracy of biplane transesophageal echocardiography in detecting left atrial thrombus. Am J Cardiol 1996;77:321-323
CrossRef | Web of Science | Medline14
Manning WJ ,Silverman DI ,Keighley CS ,Oettgen P ,Douglas PS . Transesophageal echocardiography facilitated early cardioversion from atrial fibrillation using short-term anticoagulation: final results of a prospective 4.5-year study. J Am Coll Cardiol 1995;25:1354-1361
CrossRef | Web of Science | Medline15
Stoddard MF ,Dawkins PR ,Prince CR ,Longaker RA . Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation. Am Heart J 1995;129:1204-1215
CrossRef | Web of Science | Medline16
Klein AL ,Grimm RA ,Black IW , et al. Cardioversion guided by transesophageal echocardiography: the ACUTE Pilot Study: a randomized, controlled trial: Assessment of Cardioversion Using Transesophageal Echocardiography. Ann Intern Med 1997;126:200-209
Web of Science | Medline17
Seto TB ,Taira DA ,Tsevat J ,Manning WJ . Cost-effectiveness of transesophageal echocardiographic-guided cardioversion: a decision analytic model for patients admitted to the hospital with atrial fibrillation. J Am Coll Cardiol 1997;29:122-130
CrossRef | Web of Science | Medline18
Corrado G ,Tadeo G ,Beretta S , et al. Atrial thrombi resolution after prolonged anticoagulation in patients with atrial fibrillation. Chest 1999;115:140-143
CrossRef | Web of Science | Medline19
Prystowsky EN . Management of atrial fibrillation: simplicity surrounded by controversy. Ann Intern Med 1997;126:244-246
Web of Science | Medline20
Design of a clinical trial for the assessment of cardioversion using transesophageal echocardiography (the ACUTE Multicenter Study). Am J Cardiol 1998;81:877-883
CrossRef | Web of Science | Medline21
Hlatky MA ,Boineau RE ,Higginbotham MB , et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol 1989;64:651-654
CrossRef | Web of Science | Medline22
Nelson CL ,Herndon JE ,Mark DB ,Pryor DB ,Califf RM ,Hlatky MA . Relation of clinical and angiographic factors to functional capacity as measured by the Duke Activity Status Index. Am J Cardiol 1991;68:973-975
CrossRef | Web of Science | Medline23
Klein AL ,Becker ER ,Culler SD ,Grimm RA ,Jasper SE . Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) multicenter trial: economic analysis at 8 weeks. Circulation 2000;102:Suppl II:II-575 abstract.24
Silverman DI ,Manning WJ . Role of echocardiography in patients undergoing elective cardioversion of atrial fibrillation. Circulation 1998;98:479-486
Web of Science | Medline25
Grimm RA ,Leung DY ,Black IW ,Stewart WJ ,Thomas JD ,Klein AL . Left atrial appendage “stunning“ after spontaneous conversion of atrial fibrillation demonstrated by transesophageal Doppler echocardiography. Am Heart J 1995;130:174-176
CrossRef | Web of Science | Medline26
Black IW ,Fatkin D ,Sagar KB , et al. Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation: a multicenter study. Circulation 1994;89:2509-2513
Web of Science | Medline27
Schlicht JR ,Davis RC ,Naqi K ,Cooper W ,Rao BV . Physician practices regarding anticoagulation and cardioversion of atrial fibrillation. Arch Intern Med 1996;156:290-294
CrossRef | Web of Science | Medline28
Carlsson J ,Tebbe U ,Rox J , et al. Cardioversion of atrial fibrillation in the elderly. Am J Cardiol 1996;78:1380-1384
CrossRef | Web of Science | Medline29
Weinberg DM ,Mancini J . Anticoagulation for cardioversion of atrial fibrillation. Am J Cardiol 1989;63:745-746
CrossRef | Web of Science | Medline30
Levine MN ,Raskob G ,Landefeld S ,Hirsh J . Hemorrhagic complications of anticoagulant treatment. Chest 1995;108:Suppl:276S-290S
CrossRef | Web of Science | Medline31
Wijffels MC ,Kirchhof CJ ,Dorland R ,Allessie MA . Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation 1995;92:1954-1968
Web of Science | Medline32
Shinbane JS ,Wood MA ,Jensen DN ,Ellenbogen KA ,Fitzpatrick AP ,Scheinman MM . Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 1997;29:709-715
CrossRef | Web of Science | Medline33
Weigner MJ ,Patel U ,Thomas LR , et al. Transesophageal echocardiography facilitated cardioversion from atrial fibrillation: short term safety and implications regarding maintenance of sinus rhythm. Circulation 1998;98:Suppl I:I-500 abstract.34
Orsinelli DA ,Pearson AC . Usefulness of transesophageal echocardiography to screen for left atrial thrombus before elective cardioversion for atrial fibrillation. Am J Cardiol 1993;72:1337-1339
CrossRef | Web of Science | Medline35
Grimm RA ,Agler DA ,Vaughn SE , et al. TEE-guided anticoagulation in patients undergoing electrical cardioversion of atrial fibrillation: results from the ACUTE Registry. J Am Coll Cardiol 1998;31:Suppl A:353A-353A abstract.
CrossRef | Web of Science
- Citing Articles (192)
Citing Articles
1
Karen L. Wilson, Brian M. Casey, Donald D. McIntire, Lisa M. Halvorson, F. Gary Cunningham. (2012) Subclinical Thyroid Disease and the Incidence of Hypertension in Pregnancy. Obstetrics & Gynecology 119:2, Part 1, 315-320
CrossRef2
Darryl P. Leong, Victoria Delgado, Jeroen J. Bax. (2012) Imaging for Atrial Fibrillation. Current Problems in Cardiology 37:1, 7-33
CrossRef3
Roberta Esposito, Rosa Raia, Daniela De Palma, Ciro Santoro, Maurizio Galderisi. (2012) The role of echocardiography in the management of the sources of embolism. Future Cardiology 8:1, 101-114
CrossRef4
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CrossRef5
C. Knackstedt, M. Becker, K. Mischke, R. Pauling, H.P. Brunner-La Rocca, P. Schauerte. (2011) A dedicated cardioversion unit for the treatment of atrial fibrillation. Herz
CrossRef6
Kazuko Yoshimoto, Katsufumi Mizushige, Xie Lu, Teppei Tsuji, Yasuo Yamaguchi, Tomohiro Kurozumi, Atsushi Ueki. (2011) Measurement of left atrial appendage size by transesophageal echocardiography. Journal of Medical Ultrasonics
CrossRef7
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CrossRef8
Irene A. Weiss, Noah Bloomgarden, William H. Frishman. (2011) Subclinical Hypothyroidism and Cardiovascular Risk. Cardiology in Review 19:6, 291-299
CrossRef9
R. Wheeler, N. D. Masani. (2011) The role of echocardiography in the management of atrial fibrillation. European Journal of Echocardiography 12:10, i33-i38
CrossRef10
Shinsuke Miyazaki, Ashok J. Shah, Daniel Scherr, Michel Haïssaguerre. (2011) Atrial fibrillation: Pathophysiology and current therapy. Annals of Medicine 43:6, 425-436
CrossRef11
Ali Mahajerin, Warren J. Manning. 2011. Prevention of Cardioembolic Stroke. , 179-203.
CrossRef12
FuKun W. Hoffmann, Ann S. Hashimoto, Byung Cheon Lee, Aaron H. Rose, Ralph V. Shohet, Peter R. Hoffmann. (2011) Specific antioxidant selenoproteins are induced in the heart during hypertrophy. Archives of Biochemistry and Biophysics 512:1, 38-44
CrossRef13
Vera H.M. Deneer, Norbert M. van Hemel. (2011) Is Antiarrhythmic Treatment in the Elderly Different?. Drugs & Aging 28:8, 617-633
CrossRef14
Anne B Riley, Warren J Manning. (2011) Atrial fibrillation: an epidemic in the elderly. Expert Review of Cardiovascular Therapy 9:8, 1081-1090
CrossRef15
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CrossRef16
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CrossRef17
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CrossRef18
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CrossRef19
Patrick A. Calvert, Bushra S. Rana, Anna C. Kydd, Leonard M. Shapiro. (2011) Patent foramen ovale: anatomy, outcomes, and closure. Nature Reviews Cardiology 8:3, 148-160
CrossRef20
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CrossRef21
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CrossRef22
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CrossRef23
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CrossRef24
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CrossRef25
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CrossRef26
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CrossRef27
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CrossRef28
B. Leithäuser, F. Kasch, T. Broemel, J.-W. Park. (2010) Persistierender linksatrialer Thrombus bei Vorhofflimmern unter oraler Antikoagulation. Herz 35:8, 576-581
CrossRef29
G. Morani, C. Bergamini, C. Angheben, L. Pozzani, M. Cicoira, L. Tomasi, D. Lanza, C. Vassanelli. (2010) General anaesthesia for external electrical cardioversion of atrial fibrillation: experience of an exclusively cardiological procedural management. Europace 12:11, 1558-1563
CrossRef30
Emerson L Olivares, Denise P Carvalho. (2010) Thyroid hormone metabolism in heart failure: iodothyronine deiodinases in focus. Current Opinion in Endocrinology, Diabetes and Obesity 17:5, 414-417
CrossRef31
, , , A. J. Camm, P. Kirchhof, G. Y. H. Lip, U. Schotten, I. Savelieva, S. Ernst, I. C. Van Gelder, N. Al-Attar, G. Hindricks, B. Prendergast, H. Heidbuchel, O. Alfieri, A. Angelini, D. Atar, P. Colonna, R. De Caterina, J. De Sutter, A. Goette, B. Gorenek, M. Heldal, S. H. Hohloser, P. Kolh, J.-Y. Le Heuzey, P. Ponikowski, F. H. Rutten, , A. Vahanian, A. Auricchio, J. Bax, C. Ceconi, V. Dean, G. Filippatos, C. Funck-Brentano, R. Hobbs, P. Kearney, T. McDonagh, B. A. Popescu, Z. Reiner, U. Sechtem, P. A. Sirnes, M. Tendera, P. E. Vardas, P. Widimsky, , P. E. Vardas, V. Agladze, E. Aliot, T. Balabanski, C. Blomstrom-Lundqvist, A. Capucci, H. Crijns, B. Dahlof, T. Folliguet, M. Glikson, M. Goethals, D. C. Gulba, S. Y. Ho, R. J. M. Klautz, S. Kose, J. McMurray, P. Perrone Filardi, P. Raatikainen, M. J. Salvador, M. J. Schalij, A. Shpektor, J. Sousa, J. Stepinska, H. Uuetoa, J. L. Zamorano, I. Zupan. (2010) Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 12:10, 1360-1420
CrossRef32
, , , A. J. Camm, P. Kirchhof, G. Y. H. Lip, U. Schotten, I. Savelieva, S. Ernst, I. C. Van Gelder, N. Al-Attar, G. Hindricks, B. Prendergast, H. Heidbuchel, O. Alfieri, A. Angelini, D. Atar, P. Colonna, R. De Caterina, J. De Sutter, A. Goette, B. Gorenek, M. Heldal, S. H. Hohloser, P. Kolh, J.-Y. Le Heuzey, P. Ponikowski, F. H. Rutten, , A. Vahanian, A. Auricchio, J. Bax, C. Ceconi, V. Dean, G. Filippatos, C. Funck-Brentano, R. Hobbs, P. Kearney, T. McDonagh, B. A. Popescu, Z. Reiner, U. Sechtem, P. A. Sirnes, M. Tendera, P. E. Vardas, P. Widimsky, , P. E. Vardas, V. Agladze, E. Aliot, T. Balabanski, C. Blomstrom-Lundqvist, A. Capucci, H. Crijns, B. Dahlof, T. Folliguet, M. Glikson, M. Goethals, D. C. Gulba, S. Y. Ho, R. J. M. Klautz, S. Kose, J. McMurray, P. Perrone Filardi, P. Raatikainen, M. J. Salvador, M. J. Schalij, A. Shpektor, J. Sousa, J. Stepinska, H. Uuetoa, J. L. Zamorano, I. Zupan. (2010) Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Journal 31:19, 2369-2429
CrossRef33
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CrossRef34
M. Pepi, A. Evangelista, P. Nihoyannopoulos, F. A. Flachskampf, G. Athanassopoulos, P. Colonna, G. Habib, E. B. Ringelstein, R. Sicari, J. L. Zamorano, , , M. Sitges, P. Caso. (2010) Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism: European Association of Echocardiography (EAE) (a registered branch of the ESC). European Journal of Echocardiography 11:6, 461-476
CrossRef35
A. Arya, J. S. Silberbauer, J. Vrahimides, E. Cheek, A. Mitchell, L. Boodhoo, P. Pugh, J. Large, G. Bordoli, W. Taggu, G. W. Lloyd, N. R. Patel, A. N. Sulke. (2010) First time and repeat cardioversion of atrial tachyarrhythmias - a comparison of outcomes. International Journal of Clinical Practice 64:8, 1062-1068
CrossRef36
Waldemar E. Wysokinski, Naser Ammash, Folakemi Sobande, Henna Kalsi, David Hodge, Robert D. McBane. (2010) Predicting left atrial thrombi in atrial fibrillation. American Heart Journal 159:4, 665-671
CrossRef37
Frank Xavier Scheuermeyer, Eric Grafstein, Rob Stenstrom, Grant Innes, Iraj Poureslami, Maziar Sighary. (2010) Thirty-day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter. Academic Emergency Medicine 17:4, 408-415
CrossRef38
L. F. Tops, M. J. Schalij, J. J. Bax. (2010) Imaging and atrial fibrillation: the role of multimodality imaging in patient evaluation and management of atrial fibrillation. European Heart Journal 31:5, 542-551
CrossRef39
THOMAS W. WALLACE, BRETT D. ATWATER, JAMES P. DAUBERT, DEEPAK VOORA, ANNA LISA CROWLEY, TRISTRAM D. BAHNSON, PATRICK M. HRANITZKY. (2010) Prevalence and Clinical Characteristics Associated With Left Atrial Appendage Thrombus in Fully Anticoagulated Patients Undergoing Catheter-Directed Atrial Fibrillation Ablation. Journal of Cardiovascular Electrophysiologyno-no
CrossRef40
2010. Cardiovascular Management. , 437-580.
CrossRef41
JCS Joint Working Group. (2010) Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2008). Circulation Journal 74:11, 2479-2500
CrossRef42
L. Guédon-Moreau, S. Kacet. (2009) Les enjeux du traitement antithrombotique. Annales de Cardiologie et d'Angéiologie 58, S25-S30
CrossRef43
Thomas Kleemann, Torsten Becker, Margit Strauss, Steffen Schneider, Karlheinz Seidl. (2009) Prevalence of Left Atrial Thrombus and Dense Spontaneous Echo Contrast in Patients With Short-Term Atrial Fibrillation < 48 Hours Undergoing Cardioversion: Value of Transesophageal Echocardiography to Guide Cardioversion. Journal of the American Society of Echocardiography 22:12, 1403-1408
CrossRef44
Bradley P. Knight. (2009) Transesophageal Echocardiography Before Atrial Fibrillation Ablation. Journal of the American College of Cardiology 54:22, 2040-2042
CrossRef45
Sarinya Puwanant, Brandon C. Varr, Kevin Shrestha, Sarah K. Hussain, W.H. Wilson Tang, Ruvin S. Gabriel, Oussama M. Wazni, Mandeep Bhargava, Walid I. Saliba, James D. Thomas, Bruce D. Lindsay, Allan L. Klein. (2009) Role of the CHADS2 Score in the Evaluation of Thromboembolic Risk in Patients With Atrial Fibrillation Undergoing Transesophageal Echocardiography Before Pulmonary Vein Isolation. Journal of the American College of Cardiology 54:22, 2032-2039
CrossRef46
Pieter De Meester, Vincent Thijs, Rik Willems, Werner Budts. (2009) Percutaneous closure of the left atrial appendage in atrial fibrillation: an alternative if standard treatment fails?. Interventional Cardiology 1:1, 119-131
CrossRef47
Chandra K Nair, Mark J Holmberg, Wilbert S Aronow, Xuedong Shen, Huagui Li, Dhanunjay Lakkireddy. (2009) Thromboembolism in Patients With Atrial Fibrillation With and Without Left Atrial Thrombus Documented by Transesophageal Echocardiography. American Journal of Therapeutics 16:5, 385-392
CrossRef48
GIOVANNI MORANI, MARIANTONIETTA CICOIRA, LAURA POZZANI, CARLO ANGHEBEN, GABRIELE ZANOTTO, CORRADO VASSANELLI. (2009) Outpatient Electrical Cardioversion of Atrial Fibrillation: 8 Years’ Experience. Analysis of Shock-Related Arrhythmias. Pacing and Clinical Electrophysiology 32:9, 1152-1158
CrossRef49
JAMES A. REIFFEL. (2009) Cardioversion for Atrial Fibrillation: Treatment Options and Advances. Pacing and Clinical Electrophysiology 32:8, 1073-1084
CrossRef50
Anna Maltagliati, Claudia A Galli, Gloria Tamborini, Fabrizio Celeste, Manuela Muratori, Mauro Pepi. (2009) Incidence of spontaneous echocontrast, ‘sludge’ and thrombi before cardioversion in patients with atrial fibrillation: new insights into the role of transesophageal echocardiography. Journal of Cardiovascular Medicine 10:7, 523-528
CrossRef51
Mark A. Crandall, David J. Bradley, Douglas L. Packer, Samuel J. Asirvatham. (2009) Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies. Mayo Clinic Proceedings 84:7, 643-662
CrossRef52
M. A. Crandall, D. J. Bradley, D. L. Packer, S. J. Asirvatham. (2009) Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies. Mayo Clinic Proceedings 84:7, 643-662
CrossRef53
H. Volkmann, M. Walter, C. Bergmann, E. Rose, V. Krpciar, S. Vetter. (2009) Thromboembolieprophylaxe bei Vorhofflimmern. Herzschrittmachertherapie + Elektrophysiologie 20:2, 61-69
CrossRef54
RICCARDO CAPPATO. (2009) Searching for Left Atrial Thrombi Prior to Catheter Ablation of Atrial Fibrillation: Are There Patients Who Can Safely Avoid Preablation Transesophageal Echocardiography?. Journal of Cardiovascular Electrophysiology 20:4, 385-387
CrossRef55
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CrossRef56
Donald Martin. (2009) Disseminated Intravascular Coagulation Precipitated by Thyroid Storm. Southern Medical Journal 102:2, 193-195
CrossRef57
Hua He, Junping Kang, Hailong Tao, Bin Zhen, Ming Zhang, Deyong Long, Jianzeng Dong. (2009) Conventional oral anticoagulation may not replace prior transesophageal echocardiography for the patients with planned catheter ablation for atrial fibrillation. Journal of Interventional Cardiac Electrophysiology 24:1, 19-26
CrossRef58
P. Peñafiel Verdú, A. García Alberola, M. Valdés Chávarri. (2008) Manejo de la fibrilación/flutter auricular de reciente comienzo. Medicine - Programa de Formación Médica Continuada Acreditado 10:23, 1540-1546
CrossRef59
Nicola Gaibazzi, Massimo Piepoli. (2008) TEE screening in Atrial flutter: A single-centre experience with retrospective validation of a new risk score for the presence of atrial thrombi. International Journal of Cardiology 129:1, 149-151
CrossRef60
Wilbert S. Aronow. (2008) Treatment of Atrial Fibrillation and Atrial Flutter. Cardiology in Review 16:5, 230-239
CrossRef61
Warren Walsh, Alex Brown, Jonathan Carapetis. (2008) The Diagnosis and Management of Chronic Rheumatic Heart Disease—An Australian Guideline. Heart, Lung and Circulation 17:4, 271-289
CrossRef62
Uzoma N. Ibebuogu, Ali K. Salah, Surender Malhotra, Joe B. Calkins, John W. Thornton, Mahendra Mandawat, Vincent J.B. Robinson. (2008) The D-dimer assay: A possible tool in the evaluation of atrial thrombosis. Canadian Journal of Cardiology 24:6, 517-519
CrossRef63
Ulrich Tebbe, Ralph Oeckinghaus, Karl-Friedrich Appel, Hubertus Heuer, Hendrik Haake, Egbert Eggers, Karlheinz Seidel, Jan Adams, Job Harenberg. (2008) AFFECT: a prospective, open-label, multicenter trial to evaluate the feasibility and safety of a short-term treatment with subcutaneous certoparin in patients with persistent non-valvular atrial fibrillation. Clinical Research in Cardiology 97:6, 389-396
CrossRef64
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CrossRef65
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CrossRef66
T. Lewalter, J. Tebbenjohanns, T. Wichter, M. Antz, C. Geller, K.-H. Seidl, D. Gulba, F.R. Röhrig, S. Willems. (2008) Kommentar zu „ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation – executive summary“. Der Kardiologe 2:3, 181-205
CrossRef67
ERIC N. PRYSTOWSKY. (2008) The History of Atrial Fibrillation: The Last 100 Years. Journal of Cardiovascular Electrophysiology 19:6, 575-582
CrossRef68
Anil-Martin Sinha, Johannes Brachmann, Martin Schmidt. (2008) Medikamentöse Therapie von Vorhofflimmern. Herzschrittmachertherapie + Elektrophysiologie 19:2, 50-59
CrossRef69
S. V. Patel, Greg Flaker. (2008) Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?. Clinical Cardiology 31:4, 148-152
CrossRef70
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CrossRef71
Wilbert S Aronow, Carmine Sorbera. 2008. Supraventricular Tachyarrhythmias in the Elderly. , 577-604.
CrossRef72
Susan S. Kim, Bradley P. Knight. (2008) Electrical and Pharmacologic Cardioversion for Atrial Fibrillation. Medical Clinics of North America 92:1, 101-120
CrossRef73
Benzy J. Padanilam, Eric N. Prystowsky. (2008) Atrial Fibrillation: Goals of Therapy and Management Strategies to Achieve the Goals. Medical Clinics of North America 92:1, 217-235
CrossRef74
Albert L. Waldo. (2008) Anticoagulation: Stroke Prevention in Patients with Atrial Fibrillation. Medical Clinics of North America 92:1, 143-159
CrossRef75
J. Maizel, M. Slama, S. Ederhy, A. Cohen. 2008. Évaluation hémodynamique et du risque thrombo-embolique des patients en fibrillation auriculaire. , 277-298.
CrossRef76
Margherita Sorino, Paolo Colonna, Leonardo De Luca, Scipione Carerj, Esmeralda Oliva, Salvatore M De Tommasi, Umberto Conti, Flaviano Iacopi, Carlo DʼAgostino, Nicola DʼAmato, Giacinto Pettinati, Vincenzo Montericcio, Annamaria Cualbu, Italo De Luca. (2007) Post-cardioversion transesophageal echocardiography (POSTEC) strategy with the use of enoxaparin for brief anticoagulation in atrial fibrillation patients: the multicenter POSTEC trial (a pilot study). Journal of Cardiovascular Medicine 8:12, 1034-1042
CrossRef77
Allan J Williams, Patrick J OʼShea, Graham R Williams. (2007) Complex interactions between thyroid hormone and fibroblast growth factor signalling. Current Opinion in Endocrinology, Diabetes and Obesity 14:5, 410-415
CrossRef78
Thomas C. Crawford, Hakan Oral. (2007) Cardiac Arrhythmias: Management of Atrial Fibrillation in the Critically Ill Patient. Critical Care Clinics 23:4, 855-872
CrossRef79
Karl Mischke, Thomas Schimpf, Christian Knackstedt, Peter Hanrath, Patrick Schauerte. (2007) Single-step atrial thrombus exclusion and transesophageal cardioversion in atrial fibrillation. Expert Review of Medical Devices 4:4, 549-557
CrossRef80
Daisuke Watanabe, Kazuhiko Shizuka, Toshihiko Iwamoto. (2007) High risk of cardiogenic cerebral embolism for very elderly patients in sinus rhythm with left atrial appendage flow velocity below 50
cm/s. Geriatrics & Gerontology International 7:2, 118-123
CrossRef81
NICHOLAS P. GALL, FRANCIS D. MURGATROYD. (2007) Electrical Cardioversion for AF?The State of the Art. Pacing and Clinical Electrophysiology 30:4, 554-567
CrossRef82
D. George Wyse. (2007) Anticoagulation in atrial fibrillation: A contemporary viewpoint. Heart Rhythm 4:3, S34-S39
CrossRef83
Karl Mischke, Thomas Schimpf, Ron Winograd, Christian Knackstedt, Markus Zarse, Jurgita Plisiene, Peter Hanrath, Malte Kelm, Patrick Schauerte. (2007) Simultaneous transesophageal cardioversion and echocardiography: Feasibility and safety. Heart Rhythm 4:3, 304-307
CrossRef84
Alan S. Pearlman. (2007) An Unexpected Mass on the Aortic Valve. American Heart Hospital Journal 5:2, 117-121
CrossRef85
2007. A. , 3-25.
CrossRef86
Geraldine Lee. (2007) A review of the literature on atrial fibrillation: rate reversion or control?. Journal of Clinical Nursing 16:1, 77-83
CrossRef87
Xuedong Shen, Huagui Li, Chandra K. Nair, Mark J. Holmberg, Dhanunjay Lakkireddy, David Cloutier, Karen Rovang, Tom Hee, Aryan N. Mooss, Syed M. Mohiuddin. (2007) Warfarin Therapy Initiated before Is More Beneficial Than after Transesophageal Echocardiography Detected Left Atrial Thrombus. Echocardiography 24:1,
CrossRef88
David Sidebotham. 2007. Echocardiography. , 105-119.
CrossRef89
Birke Schneider, Claudia Stöllberger, Barbara Schneider. (2007) Diagnosis of Left Atrial Appendage Thrombi by Multiplane Transesophageal Echocardiography. Circulation Journal 71:1, 122-125
CrossRef90
Caroline Schmidt-Lucke, W. Dieter Paar, Christoph Stellbrink, Uwe Nixdorff, Thomas Hofmann, Jürgen Meurer, Rolf Grewe, Werner Günther Daniel, Peter Hanrath, Andreas Mügge, Helmut U. Klein, Jan André Schmidt-Lucke. (2007) Quality of anticoagulation with unfractionated heparin plus phenprocoumon for the prevention of thromboembolic complications in cardioversion for non-valvular atrial fibrillation. Sub-analysis from the Anticoagulation in Cardioversion using Enoxaparin (ACE) trial. Thrombosis Research 119:1, 27-34
CrossRef91
Warren Smith, Margaret Hood. 2007. Arrhythmias. , 316-341.
CrossRef92
Jun Gol Song, Gyu-Sam Hwang, Young Kug Kim, Seung Hye Sung, In Cheol Choi, Jai Hyun Hwang, Sung Kang Cho, Sung Min Han. (2007) Left Atrial Thrombus Diagnosed by Transesophageal Echocardiography Immediately after Induction in a Patient with Middle Cerebral Artery Infarction - A case report -. Korean Journal of Anesthesiology 52:6, 702
CrossRef93
(2006) ACC/AHA/ESC: Guías de Práctica Clínica 2006 para el manejo de pacientes con fibrilación auricular. Versión resumida. Revista Española de Cardiología 59:12, 1329.e1-1329.e64
CrossRef94
Stéphane Ederhy, Ariel Cohen. (2006) Optimising stroke prevention in non-valvular atrial fibrillation. Expert Opinion on Pharmacotherapy 7:15, 2079-2094
CrossRef95
P. Halbfaß, A. Plewan, K. Dennig, C. Kolb, C. Schmitt. (2006) TEE-geführte Kardioversion bei Patienten mit Vorhofflimmern ohne vorherige Antikoagulation. Herzschrittmachertherapie & Elektrophysiologie 17:3, 127-132
CrossRef96
Valentin Fuster, Lars E. Rydén, David S. Cannom, Harry J. Crijns, Anne B. Curtis, Kenneth A. Ellenbogen, Jonathan L. Halperin, Jean-Yves Le Heuzey, G. Neal Kay, James E. Lowe, S. Bertil Olsson, Eric N. Prystowsky, Juan Luis Tamargo, Samuel Wann. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary. Journal of the American College of Cardiology 48:4, 854-906
CrossRef97
Valentin Fuster, Lars E. Rydén, David S. Cannom, Harry J. Crijns, Anne B. Curtis, Kenneth A. Ellenbogen, Jonathan L. Halperin, Jean-Yves Le Heuzey, G. Neal Kay, James E. Lowe, S. Bertil Olsson, Eric N. Prystowsky, Juan Luis Tamargo, Samuel Wann. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Journal of the American College of Cardiology 48:4, e149-e246
CrossRef98
Andrea Mazza, Maria Stella Fera, Marco Pugliese, Massimo Leggio, Maria Grazia Bendini, Valeria Poli, Carla Manzara, Giovanni Minardi, Paolo Giuseppe Pino, Donato Pompa, Anna Teresa Fiorella, Francesco De Santis, Ezio Giovannini. (2006) Biphasic transoesophageal vs. transthoracic electrical cardioversion of persistent atrial fibrillation. Journal of Cardiovascular Medicine 7:8, 594-600
CrossRef99
Giovanni Corrado, Allan L Klein, Mauro Santarone. (2006) Echocardiography in atrial fibrillation. Journal of Cardiovascular Medicine 7:7, 498-504
CrossRef100
Paolo Colonna, Margherita Sorino, Leonardo de Luca, Francesco Bovenzi, Italo de Luca. (2006) Antithrombotic therapy in atrial fibrillation: beyond the AFFIRM study. Journal of Cardiovascular Medicine 7:7, 505-513
CrossRef101
Mahi Lakshmi Ashwath, Gurjaipal Kang, Mike Cunningham, Dale S. Adler. (2006) Cardiogenic Shock in Hypothyroidism. Southern Medical Journal 99:5, 515-517
CrossRef102
FREDRIK HOLMQVIST, MARTIN STRIDH, JOHAN E.P. WAKTARE, LEIF SORNMO, ANDERS ROIJER, CARL J. MEURLING. (2006) Indices of Electrical and Contractile Remodeling During Atrial Fibrillation in Man. Pacing and Clinical Electrophysiology 29:5, 512-519
CrossRef103
Balachundhar Subramaniam, Marilyn F. Riley, Peter J. Panzica, Warren J. Manning. (2006) Transesophageal Echocardiographic Assessment of Right Atrial Appendage Anatomy and Function: Comparison with the Left Atrial Appendage and Implications for Local Thrombus Formation. Journal of the American Society of Echocardiography 19:4, 429-433
CrossRef104
Eyal Herzog, Emad Aziz, Sripal Bangalore, Avi Fischer, Olivier Frankenberger, Jonathan S. Steinberg. (2006) Translation of the RACE Pathway for Management of Atrial Fibrillation and Atrial Flutter Into Admission Forms. Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine 5:1, 15-17
CrossRef105
Ildiko Agoston, Tianrong Xie, Frank L. Tiller, Atiar M. Rahman, Masood Ahmad. (2006) Assessment of Left Atrial Appendage by Live Three-Dimensional Echocardiography: Early Experience and Comparison with Transesophageal Echocardiography. Echocardiography 23:2, 127-132
CrossRef106
Michael S Panutich, Bradley P Knight. (2006) Imaging techniques in cardiac electrophysiology. Expert Review of Cardiovascular Therapy 4:1, 59-70
CrossRef107
Richard G. Sheahan, Marschall S. Runge. 2006. Fibrilación auricular. , 184-195.
CrossRef108
PAMELA J. McCABE. (2005) Spheres of Clinical Nurse Specialist Practice Influence Evidence-based Care for Patients With Atrial Fibrillation. Clinical Nurse Specialist 19:6, 308-317
CrossRef109
Arun V. Raghavan, Wyatt W. Decker, Thomas D. Meloy. (2005) Management of Atrial Fibrillation in the Emergency Department. Emergency Medicine Clinics of North America 23:4, 1127-1139
CrossRef110
Harlan M. Krumholz. (2005) The Year in Epidemiology, Health Services, and Outcomes Research. Journal of the American College of Cardiology 46:7, 1362-1370
CrossRef111
Andrew Smallwood. (2005) Nurse-led elective cardioversion: an evidence-based practice review. Nursing in Critical Care 10:5, 231-241
CrossRef112
Kousik Krishnan. (2005) Atrial Fibrillation: Management for the Geriatric Patient. The American Journal of Geriatric Cardiology 14:5, 242-249
CrossRef113
Marc Sirol, Juan G.S. Aguinaldo, Philip B. Graham, Robert Weisskoff, Randy Lauffer, Gabor Mizsei, Igor Chereshnev, John T. Fallon, Ernane Reis, Valentin Fuster, Jean-François Toussaint, Zahi A. Fayad. (2005) Fibrin-targeted contrast agent for improvement of in vivo acute thrombus detection with magnetic resonance imaging. Atherosclerosis 182:1, 79-85
CrossRef114
Robert W. Rho, Richard L. Page. (2005) Asymptomatic Atrial Fibrillation. Progress in Cardiovascular Diseases 48:2, 79-87
CrossRef115
Thomas Schimpf, Karl Mischke, Jurgita Plisiene, Pal Soos, Christian Knackstedt, Markus Zarse, Felix Gramley, Lajos Patonay, Veronica Molina, Bela Merkely, Peter Hanrath, Patrick Schauerte. (2005) Single-Step Atrial Thrombus Exclusion and Internal Cardioversion of Atrial Fibrillation Via a Transesophageal Echocardiography Probe. Journal of the American College of Cardiology 46:3, 560-561
CrossRef116
Hygriv B. Rao, Sanjeev Saksena, Ravi Mitruka. (2005) Intra-Cardiac Echocardiography Guided Cardioversion to Help Interventional Procedures (ICE-CHIP) Study: Study Design and Methods. Journal of Interventional Cardiac Electrophysiology 13:S1, 31-36
CrossRef117
Marco A. Zenati, David Schwartzman. 2005. Modification of the Left Atrial Appendage. , 152-156.
CrossRef118
Brian Olshansky, Hongsheng Guo. (2005) Acute anticoagulation adjustment in patients with atrial fibrillation at risk for stroke: approaches, strategies, risks and benefits. Expert Review of Cardiovascular Therapy 3:4, 571-590
CrossRef119
Timothy D. Woods. (2005) Transesophageal echocardiography and stroke. Current Atherosclerosis Reports 7:4, 255-262
CrossRef120
Peter Bernhardt, Harald Schmidt, Christoph Hammerstingl, Berndt Lüderitz, Heyder Omran. (2005) Incidence of Cerebral Embolism after Cardioversion of Atrial Fibrillation: A Prospective Study with Transesophageal Echocardiography and Cerebral Magnetic Resonance Imaging. Journal of the American Society of Echocardiography 18:6, 649-653
CrossRef121
A. Gentric. (2005) Fibrillation atriale. EMC - Médecine 2:2, 153-159
CrossRef122
C. Stellbrink. (2005) Therapie bedrohlicher Herzrhythmusst
CrossRef123
Itzhak Kronzon, Paul A. Tunick, Marcoen F. Scholten, Richard E. Kerber, J.R.T.C. Roelandt. (2005) Combined transesophageal echocardiography and transesophageal cardioversion probe: Technical aspects. Journal of the American Society of Echocardiography 18:3, 213-215
CrossRef124
Ashish Agarwal, Meghan York, Bharat K. Kantharia, Michael Ezekowitz. (2005) Atrial Fibrillation: Modern Concepts and Management. Annual Review of Medicine 56:1, 475-494
CrossRef125
Mina K. Chung, J. David Burkhardt, Allan L. Klein. (2005) Strategies for stroke prevention in atrial fibrillation. Heart Rhythm 2:1, 103-106
CrossRef126
Christoph Stellbrink, Thomas Schimpf. (2005) Anticoagulation during Cardioversion in Patients??with Atrial Fibrillation. American Journal of Cardiovascular Drugs 5:3, 155-162
CrossRef127
J. R. Ehrlich, S. H. Hohnloser. (2005) Medikament
CrossRef128
Page, Richard L., . (2004) Newly Diagnosed Atrial Fibrillation. New England Journal of Medicine 351:23, 2408-2416
Full Text129
Robert M. Lobel, Daniel L. Lustgarten. (2004) Treatment of arrhythmias in patients with congestive heart failure. Current Treatment Options in Cardiovascular Medicine 6:6, 519-529
CrossRef130
Ann K. Wittkowsky, Kenneth W. Kenyon. (2004) The Role of Oral Direct Thrombin Inhibitors in Atrial Fibrillation. Pharmacotherapy 24:10 Part 2, 190S-198S
CrossRef131
John S. Gottdiener, James Bednarz, Richard Devereux, Julius Gardin, Allan Klein, Warren J. Manning, Annitta Morehead, Dalane Kitzman, Jae Oh, Miguel Quinones, Nelson B. Schiller, James H. Stein, Neil J. Weissman. (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. Journal of the American Society of Echocardiography 17:10, 1086-1119
CrossRef132
Heather L. Bloom. (2004) Concise review of atrial fibrillation: Treatment update considerations in light of AFFIRM and RACE. Clinical Cardiology 27:9, 495-500
CrossRef133
W. E. Wysokinski, W. G. Owen, D. N. Fass, D. D. Patrzalek, L. Murphy, R. D. Mcbane. (2004) Atrial fibrillation and thrombosis: immunohistochemical differences between in situ and embolized thrombi. Journal of Thrombosis and Haemostasis 2:9, 1637-1644
CrossRef134
G Nichol, E Huszti, J Rokosh, A Dumbrell, J McGowan, L Becker. (2004) Impact of informed consent requirements on cardiac arrest research in the United States: exception from consent or from research?. Resuscitation 62:1, 3-23
CrossRef135
M. Silvana Horenstein, Peter P. Karpawich, Michael L. Epstein, Tajinder P. Singh. (2004) Transthoracic echocardiography for precardioversion screening during atrial flutter/fibrillation in young patients. Clinical Cardiology 27:7, 413-416
CrossRef136
Yeun Tarl Fresner Ng Jao, Yi Chen, Wen-Hung Lee, Fang-Ting Tai. (2004) Thyroid Storm and Ventricular Tachycardia. Southern Medical Journal 97:6, 604-607
CrossRef137
Thomas Hofmann. (2004) Clinical application of enoxaparin. Expert Review of Cardiovascular Therapy 2:3, 321-337
CrossRef138
Icilma Fergus, Edward S Bennett, David M Rogers, Steven Siskind, Frank C Messineo. (2004) Fluoroscopic balloon–guided transesophageal echocardiography in a patient with Zenker's diverticulum. Journal of the American Society of Echocardiography 17:5, 483-486
CrossRef139
Allan L. Klein, R.Daniel Murray, Edmund R. Becker, Steven D. Culler, William S. Weintraub, Susan E. Jasper, Elizabeth A. Lieber, Carolyn Apperson-Hansen, Adrienne M. Heerey, Richard A. Grimm. (2004) Economic analysis of a transesophageal echocardiography-guided approach to cardioversion of patients with atrial fibrillation. Journal of the American College of Cardiology 43:7, 1217-1224
CrossRef140
Mark Hlatky, Alan S. Go. (2004) Economic implications of transesophageal echocardiography-guided cardioversion of atrial fibrillation. Journal of the American College of Cardiology 43:7, 1225-1227
CrossRef141
Sarah C. Middleton, Anne P. Spencer. (2004) Assessment of Hypothyroidism in Patients with Chronic Heart Failure. Pharmacotherapy 24:3, 358-361
CrossRef142
Eustachio Agricola, Michele Oppizzi, Giulio Melisurgo, Alberto Margonato. (2004) Transesophageal echocardiography: a complementary view of the heart. Expert Review of Cardiovascular Therapy 2:1, 61-75
CrossRef143
Michael W Farrar, Rhonda Taylor, Suzanne Gough. (2003) Use of an echocardiographic contrast agent to establish safety of cardioversion in a patient with a ligated left atrial appendage. Journal of the American Society of Echocardiography 16:12, 1316-1317
CrossRef144
PETER R. KOWEY, GAN-XIN YAN, TARA L. DIMINO, DUSAN Z. KOCOVIC. (2003) Overview of the Management of Atrial Fibrillation:. What is the Current State of the Art?. Journal of Cardiovascular Electrophysiology 14:s12, S275-S280
CrossRef145
GERALD V. NACCARELLI, B. JOHN HYNES, DEBORAH L. WOLBRETTE, LUNA BHATTA, MAZHAR KHAN, SORAYA SAMII, JERRY C. LUCK. (2003) Atrial Fibrillation in Heart Failure:. Prognostic Significance and Management. Journal of Cardiovascular Electrophysiology 14:s12, S281-S286
CrossRef146
S.Ahmed Tejan-Sie, R.Daniel Murray, Ian W. Black, Susan E. Jasper, Carolyn Apperson-Hansen, Jianbo Li, Elizabeth A. Lieber, Richard A. Grimm, Allan L. Klein. (2003) Spontaneous conversion of patients with atrial fibrillation scheduled for electrical cardioversion. Journal of the American College of Cardiology 42:9, 1638-1643
CrossRef147
Jane Chen, Michael W. Rich. (2003) Atrial fibrillation in the elderly. Current Treatment Options in Cardiovascular Medicine 5:5, 355-367
CrossRef148
Aneesh V. Tolat, Elizabeth M. Holper, Peter Zimetbaum. (2003) Anticoagulation Management Strategies in Patients with Atrial Fibrillation. Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine 2:3, 178-187
CrossRef149
O Paziaud, O Piot, J Rousseau, X Copie, T Lavergne, L Guize, J.Y Le Heuzey. (2003) Cardioversion électrique externe des troubles du rythme atriaux : critères prédictifs de succès. Annales de Cardiologie et d'Angéiologie 52:4, 232-238
CrossRef150
CRAIG R. ASHER, ALLAN L. KLEIN. (2003) Transesophageal Echocardiography in Patients with Atrial Fibrillation. Pacing and Clinical Electrophysiology 26:7p2, 1597-1603
CrossRef151
Minou Khazan, Sonya Scheuering, Robert Adamson, A. Scott Mathis. (2003) Prescribing Patterns and Outcomes of Enoxaparin for Anticoagulation of Atrial Fibrillation. Pharmacotherapy 23:5, 651-658
CrossRef152
I. Crozier, I. Melton, S. Pearson. (2003) Management of atrial fibrillation in the emergency department. Internal Medicine Journal 33:4, 182-185
CrossRef153
José M Ferro. (2003) Cardioembolic stroke: an update. The Lancet Neurology 2:3, 177-188
CrossRef154
Bart Keizer, Boudewijn Brans, Anne Hoekstra, Pierre M. J. Zelissen, Hans P. F. Koppeschaar, Cees J. M. Lips, Peter P. Rijk, Rudi A. Dierckx, John M. H. Klerk. (2003) Tumour dosimetry and response in patients with metastatic differentiated thyroid cancer using recombinant human thyrotropin before radioiodine therapy. European Journal of Nuclear Medicine and Molecular Imaging 30:3, 367-373
CrossRef155
Jennifer A. Larsen, David D. McPherson, Alan H. Kadish, Jeffrey J. Goldberger. (2003) Course of Intraatrial Thrombi Resolution Using Transesophageal Echocardiography. Echocardiography 20:2, 121-128
CrossRef156
Denis E. Ryono, Gary J. Grover, Karin Mellstrom. 2003. Thyroid Hormones and Thyromimetics. .
CrossRef157
Anna M. Wodlinger, John A. Pieper. (2003) Low-Molecular-Weight Heparin in Transesophageal Echocardiography–Guided Cardioversion of Atrial Fibrillation. Pharmacotherapy 23:1, 57-63
CrossRef158
Anil Yadav, Melvin Scheinman. (2003) Atrial Fibrillation in the Elderly. The American Journal of Geriatric Cardiology 12:1, 49-56
CrossRef159
J. Ryman, M. Frick, V. Frykman, M. Rosenqvist. (2003) Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation. Journal of Internal Medicine 253:1, 76-80
CrossRef160
Michael D. Ezekowitz, Pavlo I. Netrebko. (2003) Anticoagulation in management of atrial fibrillation. Current Opinion in Cardiology 18:1, 26-31
CrossRef161
Zerrin Yigit, M. Serdar Küçükoglu, Baris Ökçün, Vedat Sansoy, Deniz Güzelsoy. (2003) The Safety of Low-Molecular Weight Heparins for the Prevention of Thromboembolic Events after Cardioversion of Atrial Fibrillation. Japanese Heart Journal 44:3, 369-377
CrossRef162
Warren J Manning, David I Silverman, Todd B Seto, Marilyn J Weigner. (2002) Value of precardioversion transesophageal echocardiography in managing cardioversion of atrial fibrillation. Journal of the American College of Cardiology 40:10, 1889
CrossRef163
Edmund A. Bermudez, Ming Hui Chen. (2002) Cardiac Arrest Associated with Intravenous Propofol during Transesophageal Echocardiography before DC Cardioversion. Heart Disease 4:6, 355-357
CrossRef164
Karlheinz Seidl. (2002) Value of precardioversion transesophageal echocardiography in managing cardioversion in atrial fibrillation: Reply. Journal of the American College of Cardiology 40:10, 1889-1890
CrossRef165
Craig Bosenberg, Dave Royston. (2002) Protect the heart in the intensive care unit???but how?. Current Opinion in Critical Care 8:5, 417-420
CrossRef166
A Tilly-Gentric. (2002) Le traitement anticoagulant dans la fibrillation atriale permanente après 75 ans. La Revue de Médecine Interne 23:10, 834-839
CrossRef167
Brian Olshansky. (2002) High intensity anticoagulation for cardioversion of atrial arrhythmias? The shocking truth. Journal of the American College of Cardiology 40:5, 934-936
CrossRef168
Warren J. Manning, Peter J. Zimetbaum. (2002) Direct Current Cardioversion of Atrial Fibrillation—The Next 40 Years. Mayo Clinic Proceedings 77:9, 895-896
CrossRef169
Federico Gentile, Abdou Elhendy, Bijoy K. Khandheria, James B. Seward, Christine M. Lohse, Win-Kuang Shen, Kent R. Bailey, Samantha C. Montgomery, Kelli N. Burger, A. Jamil Tajik. (2002) Safety of Electrical Cardioversion in Patients With Atrial Fibrillation. Mayo Clinic Proceedings 77:9, 897-904
CrossRef170
W. J. Manning, P. J. Zimetbaum. (2002) Direct Current Cardioversion of Atrial Fibrillation--The Next 40 Years. Mayo Clinic Proceedings 77:9, 895-896
CrossRef171
F. Gentile, A. Elhendy, B. K. Khandheria, J. B. Seward, C. M. Lohse, W.-K. Shen, K. R. Bailey, S. C. Montgomery, K. N. Burger, A. J. Tajik. (2002) Safety of Electrical Cardioversion in Patients With Atrial Fibrillation. Mayo Clinic Proceedings 77:9, 897-904
CrossRef172
Wilbert S. Aronow, Agsf. (2002) Commentary. Journal of the American Geriatrics Society 50:8, 1446-1447
CrossRef173
Stefano Fumagalli, Lorenzo Boncinelli, Ernesta Bondi, Veronica Caleri, Silvia Gatto, Mauro Di Bari, Giorgio Baldereschi, Paolo Valoti, Giulio Masotti, Niccolò Marchionni. (2002) Does Advanced Age Affect the Immediate and Long-Term Results of Direct-Current External Cardioversion of Atrial Fibrillation?. Journal of the American Geriatrics Society 50:7, 1192-1197
CrossRef174
Pamela J. McCabe, Susan Geoffroy. (2002) Atrial Fibrillation: The Newest Frontier in Arrhythmia Management. Progress in Cardiovascular Nursing 17:3, 110-141
CrossRef175
Richard L Page, Richard E Kerber, James K Russell, Tom Trouton, Johan Waktare, Donna Gallik, Jeff E Olgin, Philippe Ricard, Gavin W Dalzell, Ramakota Reddy, Ralph Lazzara, Kerry Lee, Mark Carlson, Blair Halperin, Gust H Bardy. (2002) Biphasic versus monophasic shock waveform for conversion of atrial fibrillation. Journal of the American College of Cardiology 39:12, 1956-1963
CrossRef176
Taeko Shimizu, Saori Koide, Jaduk Yoshimura Noh, Kiminori Sugino, Kohichi Ito, Hiroe Nakazawa. (2002) Hyperthyroidism and the Management of Atrial Fibrillation. Thyroid 12:6, 489-493
CrossRef177
D CONWAY. (2002) Atrial Fibrillation. Medicine 30:6, 140-144
CrossRef178
W. S. Aronow. (2002) Management of the Older Person With Atrial Fibrillation. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 57:6, M352-M363
CrossRef179
Karlheinz Seidl, Monika Rameken, Axel Drögemüller, Margit Vater, Andreas Brandt, Harald Schwacke, Caroline Bergmeier, Ralf Zahn, Jochen Senges. (2002) Embolic events in patients with atrial fibrillation and effective anticoagulation: value of transesophageal echocardiography to guide direct-current cardioversion. Journal of the American College of Cardiology 39:9, 1436-1442
CrossRef180
Leonard I. Ganz. (2002) Management of Atrial Fibrillation. Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine 1:1, 3-11
CrossRef181
Wilbert S. Aronow. (2002) Atrial Fibrillation. Heart Disease91-101
CrossRef182
Marco R. Tullio, Shunichi Homma. (2002) Mechanisms of cardioembolic stroke. Current Cardiology Reports 4:2, 141-148
CrossRef183
Nicholas S Peters, Richard J Schilling, Prapa Kanagaratnam, Vias Markides. (2002) Atrial fibrillation: strategies to control, combat, and cure. The Lancet 359:9306, 593-603
CrossRef184
Guy Chatap, Karine Giraud, Jean-Pierre Vincent. (2002) Atrial Fibrillation in the Elderly. Drugs & Aging 19:11, 819-846
CrossRef185
G. Muqtada Chaudhry, Charles I. Haffajee. (2002) Algorithms useful in the treatment of atrial fibrillation. Current Opinion in Cardiology 17:1, 52-57
CrossRef186
Valentin Fuster, Lars E. Rydén, Richard W. Asinger, David S. Cannom, Harry J. Crijns, Robert L. Frye, Jonathan L. Halperin, G.Neal Kay, Werner W. Klein, Samuel Lévy, Robert L. McNamara, Eric N. Prystowsky, L.Samuel Wann, D.George Wyse, Raymond J. Gibbons, Elliott M. Antman, Joseph S. Alpert, David P. Faxon, Valentin Fuster, Gabriel Gregoratos, Loren F. Hiratzka, Alice K. Jacobs, Richard O. Russell, Sidney C. Smith, Werner W. Klein, Angeles Alonso-Garcia, Carina Blomström-Lundqvist, Guy De Backer, Marcus Flather, Jaromir Hradec, Ali Oto, Alexander Parkhomenko, Sigmund Silber, Adam Torbicki. (2001) ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. Journal of the American College of Cardiology 38:4, 1266
CrossRef187
(2001) Transesophageal Echocardiography to Guide Cardioversion in Patients with Atrial Fibrillation. New England Journal of Medicine 345:11, 837-839
Full Text188
Paul B Sparks, Jonathan M Kalman. (2001) Is atrial flutter a risk factor for stroke?. Journal of the American College of Cardiology 38:3, 785-788
CrossRef189
(2001) Atrial Fibrillation. New England Journal of Medicine 345:8, 620-621
Full Text190
Silverman, David I., , Manning, Warren J., . (2001) Strategies for Cardioversion of Atrial Fibrillation — Time for a Change?. New England Journal of Medicine 344:19, 1468-1470
Full Text191
&NA;. (2001) In support of transoesophageal echocardiography. Inpharma Weekly &NA;:1288, 14
CrossRef192
Kevin S. Channer. (2001) Current Management of Symptomatic Atrial Fibrillation. Drugs 61:10, 1425-1437
CrossRef
