Accuracy of biplane transesophageal echocardiography in detecting left atrial thrombus

Fatkin, Diane; Scalia, G.; Jacobs, N.; Burstow, Darryl J.; Leung, Dominic Y.; Walsh, Warren F.; Feneley, Michael P.

doi:10.1016/s0002-9149(97)89406-4

Cited by 75 publications

(30 citation statements)

References 9 publications

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“…TEE is the most sensitive and specific technique for detecting LA thrombi. 8, 9 However, TEE is an invasive and costly procedure with risk of complications such as trauma, vagal reaction or aspiration due to probe insertion, allergic reactions to topical anesthesia, and hypotension or hypoxia due to conscious sedation.…”

Section: Editorial P 1067mentioning

confidence: 99%

Transesophageal Echocardiography for Thrombus Screening Prior to Left Atrial Catheter Ablation

Yamashita

Takamatsu²,

Tada

et al. 2010

Circ J

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Background: Transesophageal echocardiography (TEE) is useful for detecting left atrial (LA) thrombus prior to percutaneous LA catheter ablation in patients with atrial fibrillation (AF). This study was designed to evaluate clinical predictors of LA thrombus and determine indications for TEE screening prior to LA ablation. Methods and Results:The study consisted of 446 patients with drug-resistant AF who were scheduled to undergo initial LA ablation (age 59±11 years, 312 males, 136 persistent AF). TEE was performed in all cases within 24 h before ablation. We assessed clinical parameters including CHADS2 score and echocardiographic parameters. LA thrombus was detected in 13 cases (2.9%) prior to LA ablation (67±8 years, 10 males, 12 persistent AF). In multiple logistic regression analysis, advanced age (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0-1.2; P<0.05), persistent AF (OR 38.1, 95%CI 1.4-988; P<0.05) and structural heart diseases (OR 29.8, 95%CI 2.8-383; P<0.01) were independent positive predictors of LA thrombus prior to ablation, while CHADS2 score and LA volume were not significant predictors. None of the 136 patients with paroxysmal lone AF whose age was below 60 years had LA thrombus prior to ablation. Conclusions:It might be reasonable to omit TEE as a screening examination for LA thrombus prior to LA ablation in younger paroxysmal lone AF patients. (Circ J 2010; 74: 1081 - 1086

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Section: Editorial P 1067mentioning

confidence: 99%

Transesophageal Echocardiography for Thrombus Screening Prior to Left Atrial Catheter Ablation

Yamashita

Takamatsu²,

Tada

et al. 2010

Circ J

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“…23,26,27 Using precardioversion TEE, Manning 24 assessed early cardioversion in patients with AF for longer than 48 h without atrial thrombi. Patients without thrombus received anticoagulation with heparin prior to and for 24 h after either pharmacological or electrical cardioversion.…”

Section: Treatment Of Spontaneous Echo Contrastmentioning

confidence: 99%

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Patel

Flaker

2007

Clinical Cardiology

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The 2006 American Heart Association guidelines for management of patients with atrial fibrillation state: ''For patients with no identifiable thrombus in the left atrium (LA) or left atrial appendage (LAA), cardioversion (CV) is reasonable immediately after anticoagulation with unfractionated heparin. Thereafter, continuation of oral anticoagulation is reasonable for an anticoagulation period of at least 4 weeks.'' For patients with thrombus identified by transesophageal echocardiography, guidelines recommend therapeutic oral anticoagulation for 3 weeks prior to and 4 weeks after elective cardioversion.Patients with spontaneous echo contrast spontaneous echo contrast (SEC) identified by transesophageal echocardiogram (TEE) have a high risk of thromboembolic events, 1 -8 however, the guidelines do not address whether patients with SEC without thrombus can be safely cardioverted. This paper reviews the literature describing the pathogenesis of SEC, how it is detected, and whether elective cardioversion is safe.On the basis of our review, we believe that the risk of cardioembolic stroke after cardioversion of a patient with SEC is low, regardless of anticoagulation. The safe conclusion is that patients with SEC on TEE should receive therapeutic anticoagulation prior to cardioversion if possible and early cardioversion is not contraindicated.

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“…Previous studies [10][11][12] reported monoplane or biplane TEE showed high sensitivity (100%) and specificity (93 to 100%) for detecting LA or LAA thrombus. Mugge et al [21] suggested that assessment of LAA function by biplane TEE may be helpful to identify subgroups of patients with an increased risk of thrombus formation.…”

Section: Discussionmentioning

confidence: 98%

“…Its image quality is superior to that of transthoracic echocardiography, and so this technique rapidly gained widespread acceptance. It has been particularly useful in evaluations of prosthetic valve dysfunction, detection of infective endocarditis, diagnosis of thoracic aortic dissection, evaluation of ventricular function in patients with poor acoustic windows, and detection of left atrial (LA) or left atrial appendage (LAA) thrombus [4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Application of a Miniaturized Biplane Transesophageal Echocardiographic Probe in Adults

et al. 2004

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Background. Standard multiplane transesophageal echocardiographic probes have large transducer tips that could increase patient discomfort, especially during esophageal intubation. A miniaturized biplane probe has been developed for pediatric use; however, its utility for adult patients is unknown. Methods.The miniaturized biplane imaging was tested in 48 anesthetized, ventilated adult patients during cardiac surgery and was compared with the standard multiplane imaging. We evaluated the image quality of cardiac structures and thoracic aorta using a five-grade scoring system. We also measured the left ventricular end-diastolic dimension (LVEDD, mm) and the peak flow velocity (cm/s) of the left atrial appendage (LAA) by pulsed-wave Doppler.Results. Esophageal intubation with the multiplane probe was unsuccessful in 1 patient, although this patient was successfully intubated with the biplane probe. There were no complications with either probe. The image qualities of the left ventricle, mitral valve, aortic valve, and ascending aorta by the biplane probe were inferior to those by the multiplane one. On the other hand, left atrium (LA), LAA, interatrial septum, aortic arch, and descending aorta were as well visualized by the biplane probe as by the multiplane one. The values of LVEDD and peak flow velocity of LAA were not different between the probes. LAA thrombus in 2 of 47 patients and aortic dissection (Stanford type A) in 7 were also well detected by both methods.Conclusions. The resolution of the two-dimensional images in the near fields of the miniaturized biplane probe was as good as the standard multiplane one. The miniaturized biplane probe was found to be applicable to the detection of LA or LAA thrombus and assessment of LAA function in adults.(J Echocardiogr 2004; 2: 83-89)

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Accuracy of biplane transesophageal echocardiography in detecting left atrial thrombus

Cited by 75 publications

References 9 publications

Transesophageal Echocardiography for Thrombus Screening Prior to Left Atrial Catheter Ablation

Transesophageal Echocardiography for Thrombus Screening Prior to Left Atrial Catheter Ablation

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Application of a Miniaturized Biplane Transesophageal Echocardiographic Probe in Adults

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