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Previous Volume 341:1313 October 21, 1999 Number 17 Next

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To the Editor: In the study by Oral and colleagues on the efficacy of ibutilide for facilitating transthoracic cardioversion of atrial fibrillation (June 17 issue),¹ patients with atrial fibrillation of more than 48 hours' duration were excluded unless "cardioversion was preceded either by transesophageal echocardiography to rule out the possibility of intracardiac thrombi or by therapeutic anticoagulation . . . for at least three weeks." Although we² and others³ have advocated the use of transesophageal echocardiography to facilitate early and safe cardioversion, the weight of published data suggests that transesophageal echocardiography be performed only after complete anticoagulation with heparin or . . . [Full Text of this Article]

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