Absence of circulating microemboli in patients with atrial fibrillation undergoing electric cardioversion

Darius G. Nabavi, Achim Allroggen, Holger Reinecke, Vendel Kemény, Dirk W. Droste, Günter Breithardt, E. Bernd Ringelstein

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Electrical cardioversion (CV) of atrial fibrillation (AF) is associated with an increased risk of stroke, and its appropriate prevention is still a matter of debate. It is known that, besides dislodgement of pre-existing intra-atrial thrombi, the 'stunned' atrium after CV is an important cause of thrombus formation and subsequent embolism. We investigated whether CV of AF is associated with occurrence of circulating microemboli (ME) representing a sensitive marker of the actual thromboembolic activity. Twenty-nine patients (22 men) aged 54 ± 13 years suffering from valvular (n = 5) or nonvalvular (n = 24) AF were studied. All but 1 patient (with recent-onset AF) had been put on oral anticoagulation (INR>2.0) for at least 3 weeks before and 4 weeks after successful CV. In all patients, exclusion of internal carotid artery stenosis and atrial thrombus was performed prior to CV. Five unilateral 1-hour transcranial Doppler ME monitorings over the middle cerebral artery were performed (1) before CV, and (2) immediately, (3) 4-6 h, (4) 24 h, and (5) 2-4 weeks after CV. Total absence of circulating ME was found before CV as well as during a cumulative monitoring time of 115 h after successful CV. Electrical CV of AF after at least 3 weeks of effective anticoagulation is not associated with occurrence of cerebral circulating ME. This finding requires further investigation including high-risk patients with AF undergoing CV based on different treatment protocols.

Original languageEnglish
Pages (from-to)95-99
Number of pages5
JournalCerebrovascular Diseases
Issue number2
Publication statusPublished - Mar 6 2001



  • Atrial fibrillation
  • Cardioversion
  • Embolism
  • Ultrasonography, diagnostic

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Nabavi, D. G., Allroggen, A., Reinecke, H., Kemény, V., Droste, D. W., Breithardt, G., & Ringelstein, E. B. (2001). Absence of circulating microemboli in patients with atrial fibrillation undergoing electric cardioversion. Cerebrovascular Diseases, 11(2), 95-99. https://doi.org/10.1159/000047619