To the Editor,

Maintaining sinus rhythm is one of the primary objectives in the treatment of atrial fibrillation. Electrical cardioversion is one of the most effective therapies for this condition. However, conversion to sinus rhythm is associated with a certain risk of embolic events, both due to the migration of pre-existing thrombi as well as their formation following recovery of atrial contraction. As such, oral anticoagulation must be administered 3-4 weeks before and 4 weeks after electrical cardioversion in patients with atrial fibrillation.

In our study1 we sought to evaluate the phenomena surrounding clinically silent embolisms that can be detected within the first few hours of the ischemic episode using new brain magnetic resonance imaging techniques.

We performed a brain resonance before and 24h after the cardioversion following the protocol from previously performed studies in patients undergoing atrial fibrillation ablation.2, 3

With regards to oral anticoagulation, we strictly controlled international normalized ratio (INR) values within the therapeutic range, such that INR was measured at least every 10 days, and the procedure was only scheduled if the patient's values were within the therapeutic range. We came to the conclusion that, maintaining anticoagulation between 2 and 3, we could avoid embolic phenomena with clinical repercussions as well as silent embolisms.

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