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[Comment] Do NOACs ENSURE safe cardioversion in atrial fibrillation?

After electrical cardioversion, thromboembolic risk increases incrementally because of left atrial stunning and subsequent recovery of function, resulting in thrombus dislodgement. Most embolic events occur within 10 days of cardioversion.1,2 Patients undergoing cardioversion for atrial fibrillation of more than 48 h in duration have a thromboembolic risk as high as 10% without anticoagulant treatment and up to 4% with anticoagulant treatment,3,4 and this risk can be decreased to less than 1% with the use of anticoagulants for 3 weeks before and 1 month after cardioversion5–8 or pre-procedural transesophageal echocardiogram (TEE) with peri-procedural and post-procedural anticoagulation treatment.