Usefulness of transoesophageal echocardiography before cardioversion in patients with atrial fibrillation and different anticoagulant regimens.
OBJECTIVE
To evaluate the prevalence of atrial thrombi in patients with atrial fibrillation undergoing different anticoagulation regimens before cardioversion; to evaluate the usefulness of transoesophageal echocardiography (TOE) guided cardioversion to prevent thromboembolic complications; and to correlate the presence of atrial thrombi with clinical and echocardiographic data.


METHODS
757 consecutive patients admitted as candidates for cardioversion of atrial fibrillation were enrolled in the study. They were divided into four groups: effective conventional oral anticoagulation, short term anticoagulation, ineffective oral anticoagulation or subtherapeutic anticoagulation, and effective oral anticoagulation with a duration of < 3 weeks for various clinical reasons. All patients underwent TOE before cardioversion; in the presence of atrial thrombi or extreme left atrial echo contrast, cardioversion was postponed. The incidence of thromboembolic events was evaluated after cardioversion.


RESULTS
Atrial thrombi were detected in 48 of the 757 (6.3%) patients. No significant differences in the percentage of atrial thrombosis were found in the four study groups. Patients with atrial thrombosis were older and had a higher percentage of mitral prosthetic valves, lower left ventricular ejection fraction, more severe atrial spontaneous echo contrast, and lower Doppler left atrial appendage velocities. 648 patients were scheduled for cardioversion. Cardioversion was successful in 89% of patients without any major thromboembolic event.


CONCLUSIONS
The prevalence of atrial thrombosis before cardioversion despite different treatments with anticoagulants is about 7% and a TOE guided approach may prevent the risk of embolic events.
Maltagliati
A
A
Centro Cardiologico I Monzino, Via Parea 4, 20123 Milan, Italy. anna.maltagliati@ccfm.it
Galli
C A
CA
Tamborini
G
G
Calligaris
A
A
Doria
E
E
Salehi
R
R
Pepi
M
M
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003663:Decision Trees; D017548:Echocardiography, Transesophageal / Q000379:methods / Q000592:standards; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013923:Thromboembolism / Q000517:prevention & control; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D018084:Ultrasonography, Interventional / Q000379:methods / Q000592:standards
D000925:Anticoagulants