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Value of echocardiography in atrial fibrillation
J Slany1, C Stöllberger, G Kronik
12nd Medical Department, Krankenanstalt Rudolfstiftung, Wien.
Insights
Echocardiography is crucial for identifying cardiac embolism sources in atrial fibrillation patients with stroke. Transesophageal echocardiography (TEE) is recommended when transthoracic echocardiography (TTE) is inconclusive, aiding diagnosis and risk assessment.
Area of Science:
- Cardiology
- Neurology
Background:
- Non-valvular atrial fibrillation increases stroke risk via embolism.
- Differentiating embolic stroke causes is critical for treatment.
Purpose of the Study:
- To outline the role of echocardiography in diagnosing cardiac embolism in atrial fibrillation patients.
- To guide the selection of echocardiographic modalities (TTE vs. TEE).
Main Methods:
- Echocardiography, including transthoracic (TTE) and transesophageal (TEE) approaches, is central.
- Clinical assessment for embolic events and stroke of uncertain origin is performed.
Main Results:
- Positive echocardiographic findings increase the likelihood of cardiac embolism as the stroke cause.
- TEE is indicated when TTE fails to identify an embolic source.
Conclusions:
- Echocardiography is essential for patients with atrial fibrillation and suspected embolism.
- TEE serves as a key diagnostic tool when TTE is insufficient, guiding further management.
Abstract:
In patients with non-valvular atrial fibrillation one must differentiate between those without a clinically suspected embolic event and those who have sustained embolism or stroke of uncertain origin. All of the latter should undergo echocardiography as part of a comprehensive search for a possible source of embolism. A positive finding will enhance the probability that the ischaemic event was indeed caused by a cardiac embolus. It must be kept in mind, especially in stroke patients, that long-term anticoagulation will expose many of them to a far higher risk of haemorrhage [26] due to multimorbidity, propensity to repeated falls and difficulties in compliance than it did to the carefully selected cohorts of the recent warfarin studies. Whenever transthoracic echocardiography (TTE) fails to disclose an unequivocal cardiac source of embolism, transesophageal echocardiography (TEE) should be performed. In persons with atrial fibrillation but no history of systemic embolisation the only rationale for performing echocardiography is to rule out heart disease in clinically suspected lone atrial fibrillation. For the rest of this group TEE remains an investigative tool.