{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:53:17Z","timestamp":1787017997930,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1995,7,15]]},"abstract":"<jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    The use of warfarin anticoagulation for several weeks before cardioversion results in a 90% reduction in the incidence of cardioversion-related thromboembolism. The mechanism of this benefit, however, is unknown; it has been widely attributed to organization and adherence of atrial thrombi, a finding observed among pathological studies of patients with rheumatic valvular disease.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods and Results<\/jats:italic>\n                    Serial transesophageal echocardiography was performed in 14 patients with nonrheumatic atrial fibrillation after identification of atrial thrombi on initial transesophageal study. All patients received warfarin anticoagulation and were followed clinically for signs of thromboembolism. Eighteen atrial thrombi were identified on initial transesophageal study, including 14 thrombi confined to the left atrial appendage, 2 in the body of the left atrium, 1 in the right atrial appendage, and 1 in the body of the right atrium. Thrombus size varied from 5 to 20 mm, and 6 were considered mobile. After a median of 4 weeks of warfarin, 16 of 18 atrial thrombi (89%; 95% CI, 73% to 100%) had completely resolved on transesophageal echocardiographic study. In addition, no new thrombi were identified on follow-up study, and no patient had a clinical thromboembolic event between studies.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    These data strongly support the hypothesis that among patients with nonrheumatic atrial fibrillation, the mechanism of clinical benefit with 3 to 4 weeks of warfarin before cardioversion is related to thrombus resolution and prevention of new thrombus formation rather than thrombus organization.\n                  <\/jats:p>","DOI":"10.1161\/01.cir.92.2.160","type":"journal-article","created":{"date-parts":[[2012,6,11]],"date-time":"2012-06-11T20:34:42Z","timestamp":1339446882000},"page":"160-163","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":124,"title":["Cardioversion of Nonrheumatic Atrial Fibrillation"],"prefix":"10.1161","volume":"92","author":[{"given":"Laura J.","family":"Collins","sequence":"first","affiliation":[{"name":"From the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division (L.J.C., P.S.D., W.J.M.), Beth Israel Hospital and Harvard Medical School, Boston, Mass, and the Cardiology Division of the John Dempsey Hospital and University of Connecticut Health Center, Farmington, Conn (D.I.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David I.","family":"Silverman","sequence":"additional","affiliation":[{"name":"From the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division (L.J.C., P.S.D., W.J.M.), Beth Israel Hospital and Harvard Medical School, Boston, Mass, and the Cardiology Division of the John Dempsey Hospital and University of Connecticut Health Center, Farmington, Conn (D.I.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"From the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division (L.J.C., P.S.D., W.J.M.), Beth Israel Hospital and Harvard Medical School, Boston, Mass, and the Cardiology Division of the John Dempsey Hospital and University of Connecticut Health Center, Farmington, Conn (D.I.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren J.","family":"Manning","sequence":"additional","affiliation":[{"name":"From the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division (L.J.C., P.S.D., W.J.M.), Beth Israel Hospital and Harvard Medical School, Boston, Mass, and the Cardiology Division of the John Dempsey Hospital and University of Connecticut Health Center, Farmington, Conn (D.I.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_1_2","first-page":"41A","volume":"19","year":"1992","unstructured":"Bialy D, Lehmann MH, Schumacher D, Steinman RT, Meissner MD. Hospitalization for arrhythmias in the United States: importance of atrial fibrillation. J Am Coll Cardiol. 1992;19:41A. 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Philadelphia Pa: FA Davis; 1990:231-249."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(80)90071-X"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(82)90236-8"},{"key":"e_1_3_3_15_2","unstructured":"Matsumura M Shah P Kyo S Omoto R. Advantages of transesophageal echo for correct diagnosis on small left atrial thrombi in mitral stenosis. Circulation. 1989;80(suppl II):II-678. Abstract."},{"key":"e_1_3_3_16_2","doi-asserted-by":"crossref","unstructured":"Acar J Cormier B Grimberg D Kawthekar G Iung B Scheuer B Farah E. Diagnosis of left atrial thrombi in mitral stenosis: usefulness of ultrasound techniques compared with other methods. 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Abstract.","journal-title":"PACE Pacing Clin Electrophysiol"},{"key":"e_1_3_3_29_2","first-page":"308","volume":"5","year":"1992","unstructured":"Chan M, Marcus R, Bednarz J, Childers R, Lang R. Contribution of transesophageal echocardiography to cardioversion protocols for atrial fibrillation. J Am Soc Echocardiogr. 1992;5:308. Abstract.","journal-title":"J Am Soc Echocardiogr"},{"key":"e_1_3_3_30_2","first-page":"28A","volume":"21","year":"1993","unstructured":"Stoddard MR, Longaker RA. Role of transesophageal echocardiography prior to cardioversion in patients with atrial fibrillation. J Am Coll Cardiol. 1993;21:28A. Abstract.","journal-title":"J Am Coll Cardiol"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.92.2.160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T11:59:48Z","timestamp":1715515188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.92.2.160"}},"subtitle":["Reduced Thromboembolic Complications With 4 Weeks of Precardioversion Anticoagulation Are Related to Atrial Thrombus Resolution"],"short-title":[],"issued":{"date-parts":[[1995,7,15]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[1995,7,15]]}},"alternative-id":["10.1161\/01.CIR.92.2.160"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.92.2.160","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,7,15]]},"assertion":[{"value":"1995-03-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"1995-05-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"1995-07-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}