[TEE-guided cardioversion in patients with atrial fibrillation without previous anticoagulation]

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Nonvalvular atrial fibrillation (AF) exceeding 48 hours duration often requires cardioversion (CV).
• Insufficient anticoagulation poses a risk of thromboembolic complications during CV.

Purpose of the Study:

• To evaluate the safety and efficacy of transesophageal echocardiography (TEE)-guided cardioversion (CV) in patients with nonvalvular atrial fibrillation (AF) of more than 48 hours duration and insufficient anticoagulation.
• To assess the incidence of periprocedural embolism and atrial thrombi detection.

Main Methods:

• 332 patients with nonvalvular AF (>48 hours) and insufficient anticoagulation were included.
• Transesophageal echocardiography (TEE) was used to exclude left atrial thrombi before cardioversion (CV).
• CV was performed within 24 hours if no thrombi were detected; otherwise, after at least four weeks of anticoagulation.

Main Results:

• In 9.9% of patients, TEE revealed left atrial or appendage thrombi, or thrombi could not be excluded.
• 383 TEEs were performed without complications.
• No thromboembolic complications were observed during periprocedural monitoring or within four weeks after 305 CV procedures.

Conclusions:

• TEE-guided CV is a safe and effective strategy for patients with nonvalvular AF persisting for over 48 hours and without prior adequate anticoagulation.
• This approach minimizes the risk of periprocedural embolism in this patient cohort.