Is Transesophageal Echocardiography Necessary before D.C. Cardioversion in Patients with a Normal Transthoracic Echocardiogram?

Abstract

Our results suggest that a selective approach may be exercised in the use of transesophageal echocardiography prior to D.C. cardioversion for atrial fibrillation. Patients with an entirely "normal" transthoracic echocardiogram may proceed directly to cardioversion without a precardioversion transesophageal echocardiogram.

Incidence and Predictors of Left Atrial Thrombus Prior to Catheter Ablation of Atrial Fibrillation

“…In the present study, no patient with an LA diameter < 4.5 cm had a thrombus finding on TEE, which is consistent with the previous studies in AF patients prior to DC cardioversion 22,23 . Our study also demonstrates that the risk of LA thrombus increases with increasing LA diameter.…”

The Role of Repeat Transesophageal Echocardiography in Patients without Atrial Thrombus Prior to Cardioversion or Ablation

“…Variables identified included a normal LVEF, normal left atrial size, and a low CHADS 2 score. 19-23 We were able to identify one study in the literature that assessed whether repeat TEE was warranted after an initial procedure with negative results. The investigators in that small ( n = 76), retrospective study identified patients who were insufficiently anticoagulated before repeat TEE for pre-CV for the return of AF.…”

Segurança da ecocardiografia transesofágica em adultos: estudo em um hospital multidisciplinar

“…The images of the heart through the esophageal technique have better definition and quality, allowing a detailed visualization of the heart structures, such as atrial appendices, valves and great vessels. Consequently, the TEE contributes with additional diagnostic information, when compared to the TTE [1][2][3] . However, the TEE is a semi-invasive examination, which requires sedation most of the times and can lead to complications related to the procedure itself or the use of sedation.…”