Patients with atrial fibrillation undergoing cardioversion will be randomized to undergo transesophageal echocardiography or they will receive warfarin for 3 weeks with an international normalized ratio (INR) value between 2.0-3.0.
If thrombus is detected in left atrium or in left atrial appendage, no cardioversion will be performed. Other patients in the both groups will undergo electrical cardioversion. All patients will have neurological examination and diffusion magnetic resonance imaging (MRI) at baseline and at postprocedural 7th day. Clinical and subclinical cerebral thromboembolic events detected by diffusion MRI will be recorded. Any bleeding events during this period will also be recorded.
- Warfarin (Coumadin®)Drug
Other Names: Coumadin; Acenocoumarol Intervention Desc: warfarin, dabigatran etexilate, rivaroxaban, apixaban, edoxaban usage ARM 1: Kind: Experimental Label: Warfarin Group Description: This arm includes the patients with atrial fibrillation who take warfarin four weeks before electrical cardioversion.
- Cardioversion Procedure
Intervention Desc: Electrical or medical cardioversion and spontaneous sinus rhythm return ARM 1: Kind: Experimental Label: Transesophageal Echocardiography group Description: This arm includes the patients with atrial fibrillation who undergo transesophageal echocardiography-guided cardioversion ARM 2: Kind: Experimental Label: Warfarin Group Description: This arm includes the patients with atrial fibrillation who take warfarin four weeks before electrical cardioversion.
- Allocation: Randomized
- Masking: Double Blind (Investigator, Outcomes Assessor)
- Purpose: Treatment
- Endpoint: Safety Study
- Intervention: Parallel Assignment
|Type||Measure||Time Frame||Safety Issue|
|Secondary||silent cerebral thromboemboli||1 week||Yes|