title: The role of repeat transesophageal echocardiography in patients without atrial thrombus prior to cardioversion or ablation.
abstract: BACKGROUND
  Cardioversion (CV) and radiofrequency catheter ablation (RFA) are often used to restore sinus rhythm in patients with atrial fibrillation (AF). These procedures are associated with a risk for stroke. The use of transesophageal echocardiography (TEE) to guide the management of AF is a validated strategy for patients in whom CV is planned, as well patients before RFA. For patients in whom the initial procedure fails, repeat TEE is often performed before repeat CV or RFA. The aim of this study was to test the hypothesis that patients with initial negative results on TEE would be unlikely to have thrombi detected on subsequent TEE and thus may avoid repeat procedures.
  
  
  METHODS
  A total of 2,999 patients with AF were identified via retrospective review who had undergone TEE before CV or RFA, and 418 of these individuals underwent repeat TEE. After excluding patients who underwent repeat TEE >365 days from the initial study (n = 135) and those with thrombi on initial TEE (n = 20), 263 patients who had underwent two or more examinations were identified and analyzed.
  
  
  RESULTS
  Of 263 eligible patients, two (0.8%; 95% confidence interval, 0.21-2.7%) had thrombi on subsequent TEE.
  
  
  CONCLUSIONS
  Fewer than 1% of patients with AF with negative results on baseline TEE had thrombi detected on repeat TEE before subsequent CV or RFA. Thus, it may be possible to selectively screen patients to identify those at low risk for developing thrombi subsequent to negative results on initial TEE, especially if patients are in sinus rhythm. These results suggest the need for a prospective trial to definitively answer the question regarding repeat TEE in low-risk patients.
authors: The Ohio State University, Division of CardiovascularMedicine, 473 West 12th Avenue,Columbus, OH 43210, USA. sakima.smith@osumc.edu
authors: Sakima A
authors: SA
authors: Smith
authors: Philip F
authors: PF
authors: Binkley
authors: Randi E
authors: RE
authors: Foraker
authors: Haikady N
authors: HN
authors: Nagaraja
authors: David A
authors: DA
authors: Orsinelli
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control