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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 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) , the hemorrhagic rate was sign ificantly 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% 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.