Routine Transesophageal Echocardiography in Atrial Fibrillation Before Electrical Cardioversion to Detect Left Atrial...

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Transesophageal echocardiography (TEE) is not routinely used before electrical cardioversion (ECV) for atrial fibrillation (AF) in anticoagulated patients.
• Understanding the prevalence and predictors of left atrial thrombus (LAT) and spontaneous echo-contrast (SEC) is crucial for optimizing ECV safety.

Purpose of the Study:

• To investigate the rates of LAT and SEC in patients undergoing ECV for AF, comparing anticoagulated and non-anticoagulated individuals.
• To identify independent predictors of LAT and SEC in this patient cohort.

Main Methods:

• Retrospective analysis of TEE findings in 403 patients undergoing ECV for AF.
• Assessment of anticoagulation status (none, novel oral anticoagulants, warfarin INR>2, warfarin INR<2).
• Multivariate analysis to determine independent predictors of LAT and SEC.

Main Results:

• LAT was found in 10.1% and SEC in 38.2% of patients.
• Lower left ventricular ejection fraction (LVEF) was associated with both LAT and SEC.
• Higher CHADSVASC scores and warfarin use (INR>2) were independently associated with increased SEC risk.

Conclusions:

• TEE before ECV identifies significant findings (LAT/SEC) in over a third of AF patients, regardless of anticoagulation.
• LVEF and CHADSVASC score are key factors influencing LAT and SEC development.
• SEC rates are higher than expected in anticoagulated patients, with warfarin therapy showing a positive correlation.