Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation

Stoddard, Marcus F.; Dawkins, Phillip R.; Prince, Charles R.; Longaker, Rita A.

doi:10.1016/0002-8703(95)90405-0

Cited by 113 publications

(53 citation statements)

References 37 publications

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“…[6][7][8][9] In these reports, however, most patients had AF of short duration before transesophageal study. Manning, et al 9) studied 230 patients with AF with TEE and found RAA thrombus in 6 (2.6%).…”

Section: Discussionmentioning

confidence: 90%

“…[1][2][3][4][5] These studies have highlighted the importance of LAA function in patients with atrial fibrillation (AF). Recently, right atrial appendage (RAA) thrombi [6][7][8][9] and depressed RAA function 10) have been reported in patients with AF. However, to date there have been no prospective studies designed to assess RAA function in chronic nonvalvular AF.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation.

Bilge¹,

Eryonucu²,

Güler³

et al. 2000

Jpn Heart J

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SUMMARYTo assess right atrial appendage (RAA) flow and its possible relationship to left atrial appendage (LAA) flow in chronic nonvalvular atrial fibrillation (AF), transesophageal echocardiography (TEE) was performed in 26 patients with chronic nonvalvular AF (group I). For the purpose of comparison, an additional group of 27 patients with chronic valvular AF due to mitral stenosis (group II) was analyzed. The clinically estimated duration of AF in group I was significantly longer than that of group II (8.7 ± 3.4 versus 2.7 ± 1.1 years). Although right atrial size and RAA maximal area were larger in group I than those in group II, left atrial size was larger in group II than that in group I. Group II had larger LAA maximal areas than group I, but this difference did not reach statistical significance. The two groups were not different with respect to the RAA or LAA emptying velocities. Significant correlations were observed between echocardiographic parameters of the two atria in patients with nonvalvular AF (r range, 0.4 to 0.7). In contrast, in patients with valvular AF, no correlation was observed between the echocardiographic parameters of the two atria (appendage emptying velocity, r = 0.38, p = 0.051; atrial size, r = − 0.03, p = 0.89; maximal appendage area, r = 0.07, p = 0.75, respectively). There were no significant differences in the presence of right and left atrial spontaneous echo contrast and thrombus between the groups. All of the right and left atrial thrombi were confined to their respective appendages and were found in the atria with spentaneous echo contrast. Both RAA and LAA thrombi were present in one patient. In conclusion, our findings suggest that AF could affect both atria equally in nonvalvular AF, in contrast to valvular AF. Therefore, the assessment of RAA function as well as LAA may be important in patients with chronic nonvalvular AF. (Jpn Heart J 2000; 41: 451-462)

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation.

Bilge¹,

Eryonucu²,

Güler³

et al. 2000

Jpn Heart J

View full text Add to dashboard Cite

show abstract

“…21,28 -33 Though these trials did not directly look at the relationship between the presence of SEC on TEE and postcardioversion thromboembolic risk, they did incorporate a large number of patients with SEC into the cardioversion group (Table I). These studies showed a low thromboembolic risk despite varying methods of anticoagulation, including studies with no or subtherapeutic anticoagulation 28,29,32 prior to cardioversion.…”

Section: Reviews Continuedmentioning

confidence: 99%

“…Stoddard 28 demonstrated that patients receiving anticoagulation following conventional treatment had a higher prevalence of both thorombus and SEC in LA compared with patients who underwent cardioversion early. Corrado 30 demonstrated that patients with and <4 weeks duration of AF had a significantly better immediate success rate of CV than those with longer duration of AF (96.9% versus 85%); improved outcome was maintained at 1 month.…”

Section: Reviews Continuedmentioning

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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“…In more than 1300 patients previously studied by North American and European investigators, there was only 1 documented embolic event in cases involving treatment guided by TEE with short-term anticoagulation. 20,[21][22][23] The TEE-guided approach may reduce the time to CV compared with the conventional approach, as shown by the ACUTE Pilot Study (4.8 versus 0.6 weeks, P < 0.01).…”

Section: Discussionmentioning

confidence: 92%

The Safety of Low-Molecular Weight Heparins for the Prevention of Thromboembolic Events after Cardioversion of Atrial Fibrillation

et al. 2003

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SUMMARYTransesophageal echocardiography (TEE) guided early cardioversion (CV) in conjunction with short-term anticoagulation has been shown to be safe, and an alternative to prolonged conventional anticoagulation therapy. Recently, low molecular weight heparins (LMWHs) have been used successfully as an alternative to standard heparin therapy obviating the need for hospitalization and APTT monitoring. The aim of this study was to determine the feasibility and safety of TEE guided early cardioversion in conjunction with short-term LMWH use in patients with nonvalvular atrial fibrillation (NVAF).The study group consisted of 172 consecutive patients with NVAF. Before TEE, 90 patients received LMWH (Dalteparin 2 × 5,000U) and 82 patients received standard heparin (UFH) (5,000U bolus followed by infusion to raise APTT to 1.5 times control). TEE was performed and the left atrium and left atrial appendage were examined thoroughly for the presence of thrombus. One patient from each group was excluded due to detection of a left atrial thrombus by TEE. Immediately after TEE, CV was attempted and warfarin was initiated. All patients received warfarin for one month after CV. In the LMWH group, 89 of 90 patients (98.9%) were successfully cardioverted. CV was successful in 97.5% of the patients in the UFH group. None of the patients experienced thromboembolic events during the four weeks after CV.TEE guided early CV in conjunction with short-term LMWH treatment is as safe as UFH for the prevention of thromboembolic events after CV. (Jpn Heart J 2003; 44: 369-377)

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Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation

Cited by 113 publications

References 37 publications

Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation.

Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation.

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

The Safety of Low-Molecular Weight Heparins for the Prevention of Thromboembolic Events after Cardioversion of Atrial Fibrillation

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