How is postcardioversion stunning managed in atrial flutter (AFL)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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In atrial fibrillation, postcardioversion stunning of the left atrial appendage is thought to contribute to thrombogenicity. [24] This phenomenon may last as long as 4 weeks in patients with atrial fibrillation and may be related to how long patients have been in the arrhythmia.

Stunning of the left atrial appendage also occurs after conversion from atrial flutter to sinus rhythm (whether electrical or spontaneous), although to a lesser degree. Left atrial and left atrial appendage function decrease immediately after conversion and, in one study, spontaneous echo contrast was noted to develop within 5 minutes after conversion in 43% of patients. This is thought to be the source of emboli in patients in whom TEE revealed no evidence of thrombus but who had a thromboembolic event after cardioversion.

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