TEE screening in atrial flutter: a single-centre experience with retrospective validation of a new risk score for the presence of atrial thrombi.
Transesophageal echocardiography (TEE) has been proposed as a screening tool to exclude the presence of atrial thrombi and left atrial spontaneous echocontrast before cardioverting persistent atrial flutter (AFl) and atrial fibrillation (AF). However in pure AFl a very low prevalence of atrial thrombi has been observed by many investigators: a confirmation of this finding would make TEE screening redundant. We review our database of patients with AFl who underwent TEE screening before cardioversion in the last 5 years. A new risk score for the presence of left atrial thrombus (AFLAT score) is here proposed, as a potential tool to avoid unnecessary TEE exams. Out of the 106 patients examined, in fourteen left atrial thrombi were diagnosed (13%). Only two cases belonged to the pure AFl subgroup (prevalence=3%), while twelve cases were detected in the subgroup of AFl patients with previous AF episodes (prevalence=32%, p<0.001). All of the fourteen patients with a positive TEE for thrombus were identified by a AFLAT score >2. The validation of this index in a larger and prospective setting would lead to a 85% reduction in unnecessary TEE exams in patients with pure AFl undergoing cardioversion.
Gaibazzi
Nicola
N
Piepoli
Massimo
M
D001282:Atrial Flutter / Q000150:complications / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal / Q000592:standards*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000150:complications / Q000000981:diagnostic imaging*