Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk...

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Thromboembolism can occur after cardioversion for atrial fibrillation (AF) or flutter, even with transoesophageal echocardiography (TOE) exclusion of left atrial thrombi.
• Identifying patients at low risk for cardioversion without prior anticoagulation is crucial.

Purpose of the Study:

• To define criteria using TOE for selecting patients with AF or flutter for immediate cardioversion without prior anticoagulation.
• To assess the safety and efficacy of this approach compared to conventional anticoagulation.

Main Methods:

• 242 patients with AF/flutter underwent TOE.
• Patients were divided into immediate cardioversion (Group A) or conventional warfarin (Group B) based on TOE findings: no thrombi, no spontaneous echo contrast, and left atrial appendage outflow velocity >0.25 m/s.
• Group A received low molecular weight heparin and warfarin prior to cardioversion.

Main Results:

• 162 patients in Group A underwent immediate cardioversion; 80 in Group B received conventional warfarin.
• No thromboembolic events occurred in Group A post-cardioversion.
• One-month sinus rhythm maintenance was significantly higher in Group A (75%) than Group B (45%).

Conclusions:

• Transoesophageal echocardiography criteria (no thrombi, no spontaneous echo contrast, LAA outflow velocity ≥0.25 m/s) enable safe cardioversion in approximately two-thirds of AF/flutter patients without prior anticoagulation.
• This strategy leads to better sinus rhythm maintenance compared to prolonged warfarin therapy.