摘要
Background: Electrical cardioversion in patients with atrial fi- brillation(AF) is associated with an increased risk of stroke. We compared a transesophageal echocardiography(TEE)- guided strategy with a conventional strategy in patients with AF >2 days’ duration undergoing electrical cardioversion over a 6- month follow- up. Methods: The ACUTE study was a multicenter, randomized, clinical trial, with 1222 patients. Six- month follow- up was available in 1034 patients(85% ), 525 in the TEE group and 509 in the conventional group. The primary composite end points were cerebrovascular accident, transient ischemic attack, and peripheral embolism at 6 months, which was a prespecified time point. Secondary end points were hemorrhage, mortality, and sinus rhythm. Results: At 6 months, there was no difference in composite embolic events between the TEE group and the conventional group(10 [2% ] vs 4 [0.8% ]; risk ratio(RR) 2.47, 95% CI 0.78- 7.88; P=.11). However, the hemorrhagic rate was significantly lower in the TEE group(23 [4.4% ] vs 38 [7.5% ]; RR 0.58, 96% CI 0.35- 0.97; P=.04). There was no difference between the 2 treatment groups in all- cause mortality(21 [4% ] vs 14 [2.8% ]; RR 1.48, 95% CI 0.76- 2.92; P=.25) and in the occurrence of normal sinus rhythm between the 2 groups(305 [62.2% ] vs 280 [58.1% ]; P=.51). Sinus rhythm at 6 months was more common in the TEE- guided group, in those patients who had direct current cardioversion(238 [62.5% ] vs 151 [53.9% ]; P=.03). Conclusion: The TEE- guided strategy may be considered a clinically effective alternative to a conventional anticoagulation strategy for patients with AF of >2 days’ duration undergoing electrical cardioversion over a 6- month period.
Background： Electrical cardioversion in patients with atrial fi-brillation（AF） is associated with an increased risk of stroke. We compared a transesophageal echocardiography （TEE） -guided strategy with a conventional strategy in patients with AF 〉 2 days＇ duration undergoing electrical cardioversion over a 6-month follow-up. Methods： The ACUTE study was a multicenter, randomized, clinical trial, with 1222 patients. Six-month follow-up was available in 1034 patients（85% ）, 525 in the TEE group and 509 in the conventional group. The primary composite end points were cerebrovascular accident, transient ischemic attack, and peripheral embolism at 6 months, which was a prespecified time point. Secondary end points were hemorrhage, mortality, and sinus rhythm. Results： At 6 months, there was no difference in composite embolic events between the TEE group and the conventional group（ 10 [2% ] vs 4 [0.8%]; risk ratio（RR） 2.47, 95% CI 0.78- 7.88; P =. 11 ） . However, the hemorrhagic rate was significantly lower in the TEE group（23 [4.4% ] vs 38 [7.5%]; RR0.58, 96% CI 0.35-0.97; P=.04） .
