Vitamin K Antagonists Versus Novel Oral Anticoagulants for Elective Electrical Cardioversion of Atrial Fibrillation.

BACKGROUND: The management strategy for patients with atrial fibrillation (AF) is often very complex, electrical cardioversion (EC) being often used to restore sinus rhythm in those patients. The increased risk of thromboembolic complications was lowered using anticoagulation therapy. Usually, the anticoagulation was achieved using vitamin K antagonists (VKAs), but over the last years we witnessed a wide implementation of the novel oral anticoagulants (NOACs). STUDY QUESTION: Study question was to compare the efficacy of NOACs versus VKAs in patients undergoing elective EC for persistent AF, by assessing the presence of left atrial spontaneous contrast and left atrial thrombi (LACS), as well as the occurrence of the thromboembolic events in the first month after the procedure. STUDY DESIGN: A prospective study, including patients with persistent AF enrolled between January 1, 2015 and December 31, 2016, was conducted in 2 tertiary cardiology clinics. In all these patients, a management strategy based on EC was considered for the treatment of the disease. All patients received anticoagulant therapy for at least 3 weeks before cardioversion. The data of 103 patients were analyzed. RESULTS: The patients were divided into 2 groups: group A-VKAs treated-included 45 patients (43.68%), mean age 65.3 ± 12.47, 36% women; group B-NOACs treated-included 58 patients (56.31%), mean age 66.4 ± 9.79, 46% women. There was a trend toward higher incidence of left atrial thrombi in group B (16.28%) versus group A (7.69%), but the difference was not statistically significant (P = 0.5). The incidence of LACS was 40% in group A and 29% in group B, (P = 0.54). CONCLUSION: There are no statistically significant differences between the transesophageal echocardiography characteristics of left atrium and left atrial appendage examinations in the patients who received anticoagulation with VKAs as compared to patients who received anticoagulation with NOACs.

Does Phantom Tumor Really Exist?!

Localized interlobar effusion in congestive heart failure (known as phantom tumor or vanishing tumor of the lung) is an uncommon entity. We report a case of a 61-year-old man who presented to the Emergency Departament with a two week history of dyspnoea, palpitations, dry cough and intermitent anterior chest pain. A posteroanterior chest radiography showed a nodular mass in the medium third of the right hemithorax suggestive of a pulmonary tumor. With this supposition of diagnosis, the patient was admitted to the Pneumology Departament for further investigations. Left ventricular systolic dysfunction was identified on the echocardiographic examination, in the presence of atrial flutter with 2 to 1 block. Lateral chest X-ray confirmed the presence of a pleural effusion with complete regression of "the lung tumor" after ten days of congestive heart failure treatment, avoiding other expensive and unnecessary investigations.