[Transesophageal echocardiography in electrical cardioversion: Is it possible to predict conversion to sinus rhythm?]

Due to its ability to safely exclude thrombi, transesophageal echocardiography (TEE) is now routinely performed in patients proposed for electrical cardioversion. However, what is the value of TEE in predicting conversion to sinus rhythm in patients with atrial fibrillation (AF)? To answer this question, TEE was performed in 21 patients with chronic AF before elective cardioversion. Patients were divided in two groups according to the outcome of cardioversion: Group A--Restoration of sinus rhythm achieved: Group B--atrial fibrillation persisted. The echocardiographic variables used to compare both groups were 1--Left Atrial size; 2--Left Atrial Appendage (LAA) systolic and diastolic dimensions; 3--LAA emptying and filling velocities; 4--LAA emptying fraction; 5--Presence of LAA spontaneous contrast. The clinical variable evaluated was 6--therapy with oral amiodarone for more than 2 weeks (> or = 200 mg/day). The results of this study showed that patients with smaller LA, adequately treated with amiodarone and with higher LAA emptying and filling velocities, have the greatest probability of conversion to sinus rhythm.