title: National use of the transesophageal echocardiographic-guided approach to cardioversion for patients in atrial fibrillation.
abstract: Transesophageal echocardiographic (TEE)-guided cardioversion of patients in atrial fibrillation (AF) of >2 days' duration is used as an alternative to conventional therapy. The purpose of this study was to investigate practice patterns employed for stroke prophylaxis in patients with AF who underwent cardioversion, and to determine the relative use of conventional and TEE-guided management strategies. We forwarded regionally stratified survey questionnaires to 947 clinical practices within the United States. The 10-question questionnaire queried demographic and clinical practice volumes and practices for managing patients with AF who underwent cardioversion. In addition, we used historical data to determine longitudinal use patterns of the TEE-guided approach for a large institution over 7 years. The 197 completed and returned surveys yielded a return rate of 20.8%. The TEE-guided approach was employed in approximately 12% of total cardioversions, but 75% of practices indicated that they employed transesophageal echocardiography only occasionally. The TEE-guided approach was associated with community size (r = 0.19; p<0.008), type of practice (r = 0.26; p = 0.001), total use of transesophageal echocardiography (r = 0.48; p<0.001), and volume of cardioversions (r = 0.28; p<0.001). Importantly, there was little consensus on the most appropriate clinical indications for TEE-guided cardioversions, and the proportions of TEE-guided cardioversion to total number of electrical cardioversions remained stable over 7 years. Practice volume and physician training may be the most important variables in the adoption of the TEE approach.
authors.affiliation: Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Murray
authors.forename: A S
authors.initials: AS
authors.lastname: Goodman
authors.forename: E A
authors.initials: EA
authors.lastname: Lieber
authors.forename: S E
authors.initials: SE
authors.lastname: Jasper
authors.forename: R A
authors.initials: RA
authors.lastname: Grimm
authors.forename: M J
authors.initials: MJ
authors.lastname: Garcia
authors.forename: D M
authors.initials: DM
authors.lastname: Miller
authors.forename: A L
authors.initials: AL
authors.lastname: Klein
mesh_terms: D000553:Ambulatory Care; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000628:therapy*; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States