title: Simultaneous transesophageal cardioversion and echocardiography: feasibility and safety.
abstract: BACKGROUND
  Transesophageal echocardiography (TEE) is routinely used to exclude atrial thrombus prior to cardioversion of atrial fibrillation (AF). Because the TEE probe lies adjacent to the atria, cardioversion using an electrode attached to the TEE probe should allow for immediate low-energy transesophageal cardioversion.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate a cardioversion electrode sheath that can be affixed to conventional TEE probes for simultaneous thrombus exclusion and cardioversion of AF.
  
  
  METHODS
  A thin electrode was integrated into a latex or polyurethane sheath covering a conventional TEE probe. TEE thrombus exclusion and biphasic transesophageal cardioversion using a step-up protocol were performed during deep sedation. Esophagoscopy was performed immediately after cardioversion and after 1 week.
  
  
  RESULTS
  TEE was performed in 27 patients. One patient showed left atrial thrombi. Transesophageal cardioversion was successful in 25 of the remaining 26 patients. Mean atrial cardioversion threshold was 63 +/- 48 J. Transesophageal cardioversion restored sinus rhythm in two patients with unsuccessful transthoracic cardioversion. Transesophageal cardioversion in deep sedation was well tolerated. Esophagoscopy revealed slight mucosal damage in three patients at the site of shock application; two of these patients showed signs of gastroesophageal reflux disease. Mucosal damage unrelated to the site of shock delivery was noted in three patients.
  
  
  CONCLUSIONS
  Atrial thrombus exclusion and transesophageal cardioversion of AF via a disposable cardioversion sheath offers the opportunity to perform transesophageal cardioversion and TEE thrombus exclusion during one sedation. It may not be suitable for use in patients with gastroesophageal reflux disease. Transesophageal cardioversion may establish sinus rhythm in selected patients refractory to transthoracic cardioversion.
authors.affiliation: Department of Cardiology, RWTH Aachen University, Aachen, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Mischke
authors.forename: Thomas
authors.initials: T
authors.lastname: Schimpf
authors.forename: Ron
authors.initials: R
authors.lastname: Winograd
authors.forename: Christian
authors.initials: C
authors.lastname: Knackstedt
authors.forename: Markus
authors.initials: M
authors.lastname: Zarse
authors.forename: Jurgita
authors.initials: J
authors.lastname: Plisiene
authors.forename: Peter
authors.initials: P
authors.lastname: Hanrath
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Patrick
authors.initials: P
authors.lastname: Schauerte
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy; D017147:Defibrillators, Implantable; D017548:Echocardiography, Transesophageal / Q000009:adverse effects; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004869:Equipment Safety; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D012107:Research Design; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome