Transoesophageal echocardiography before DC cardioversion: a survey of clinical practice in the UK

Transoesophageal echocardiography (TOE) can be used to expedite DC cardioversion (DCCV) in the absence of adequate anticoagulation. There are no guidelines for the management of sedation or general anaesthetic. We performed a survey of NHS echocardiography departments to determine UK practice. Responses were received from 95 (50%) of 189 centres, and TOE-guided DCCV was performed in 81 centres. The numbers were <10 a year in 41 (50%), 10 - 50 in 31 (38%), 50 - 100 in 8 (10%) and >100 in 4 (5%) centres. Sedation for TOE was a usual practice in 67 (80%) centres but often temporally disconnected from DCCV due to logistical reasons. TOE under general anaesthetic was performed in 35 (43%) centres and as the usual method in 16 (20%). The patient was in the supine position with endotracheal intubation in 20 (57%) of centres, but without any form of airway protection while supine in 5 (14%). There is variability in practice across centres in the UK, in part due to limitations to services in most centres but also because of an absence of UK guidelines. The development of national standards may address this and aid in the development of local business cases to extend services.