title: Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion.
abstract: To evaluate a diagnostic value of transoesophageal echocardiogram (TEE) in appropriately anticoagulated patients with a non-valvular atrial fibrillation (AF) and to establish possible additional indications for TEE; to evaluate the incidence of left atrial (LA) thrombi in appropriately anticoagulated patients in daily clinical practice.
  
  
  
  This retrospective study analyses data of 432 patients who had been anticoagulated by means of oral anticoagulants (OACs) prior to planned cardioversion during the period from 2012 to 2015. Thromboembolic (TE) and bleeding risks were assessed using CHA2DS2-VASc and HAS-BLED scores. Transthoracic and transoesophageal echocardiograms were evaluated. TE complications during 30 days after discharge were assessed.
  
  
  
  432 patients were selected, aged from 22 to 89 years (mean 65.0 ±11.5), 277 (64.1%) males and 155 (35.9%) females, 306 (70.8%) on warfarin and 126 (29.2%) on non-vitamin K antagonist oral anticoagulants (NOAC). Mean CHA2DS2-VASc score was 3.5 ±1.5. TEE was performed for 120 (27.8%) patients, more frequently for patients on NOACs and for ones with III° LA enlargement. TEE revealed LA thrombi in seven (5.8%) of the patients. In warfarin and NOACs groups thrombi were revealed in five (7.0%) and two (4.1%) patients, respectively. TEE did not reveal any thrombi in patients with normal left ventricular (LV) function; however, thrombi were found in two (6.1%) patients with slightly decreased LV function, and in five (17.9%) patients with markedly decreased LV function. In patients with decreased left ventricular ejection fraction (LVEF) thrombi in LA were found more frequently than in patients with normal and slightly decreased LVEF (17.9% vs 2.2%, p=0.008). CHA2DS2-VASc score of all 7 patients was ≥5. None of the patients after cardioversion had TE complications 30 days after discharge.
  
  
  
  The risk of LA thrombi in patients prepared for scheduled cardioversion in line with the guidelines is low. Higher risk of thrombi was present in patients with decreased LVEF (≤40%), CHA2DS2-VASc ≥5. In order to assess more accurately indications to perform TEE for appropriately anticoagulated patients prior to scheduled cardioversion a study with larger number of patients is required.
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinics, 2 Santariškių St., LT -08661, Vilnius, Lithuania.|Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, 21 Čiurlionio St., LT-03101, Vilnius, Lithuania.
authors.forename: Jūratė
authors.initials: J
authors.lastname: Barysienė
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinics, 2 Santariškių St., LT -08661, Vilnius, Lithuania. zebrauskaite.aiste@gmail.com.|Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, 21 Čiurlionio St., LT-03101, Vilnius, Lithuania. zebrauskaite.aiste@gmail.com.
authors.forename: Aistė
authors.identifier: 0000-0003-4049-874X
authors.initials: A
authors.lastname: Žebrauskaitė
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinics, 2 Santariškių St., LT -08661, Vilnius, Lithuania.|Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, 21 Čiurlionio St., LT-03101, Vilnius, Lithuania.
authors.forename: Dovilė
authors.initials: D
authors.lastname: Petrikonytė
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinics, 2 Santariškių St., LT -08661, Vilnius, Lithuania.|Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, 21 Čiurlionio St., LT-03101, Vilnius, Lithuania.
authors.forename: Germanas
authors.initials: G
authors.lastname: Marinskis
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinics, 2 Santariškių St., LT -08661, Vilnius, Lithuania.|Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, 21 Čiurlionio St., LT-03101, Vilnius, Lithuania.
authors.forename: Sigita
authors.initials: S
authors.lastname: Aidietienė
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinics, 2 Santariškių St., LT -08661, Vilnius, Lithuania.|Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, 21 Čiurlionio St., LT-03101, Vilnius, Lithuania.
authors.forename: Audrius
authors.initials: A
authors.lastname: Aidietis
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D004334:Drug Administration Schedule; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock / Q000009:adverse effects; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Cardioversion; Non-vitamin K antagonist oral anticoagulants; Thromboembolism; Transoesophageal echocardiogram