Transesophageal Echocardiography Can Detect Atrial Fibrillation Masked by a Pacemaker: A Case Series

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Atrial fibrillation is a significant risk factor for cerebral infarction (stroke).
• New-onset atrial fibrillation is frequently identified after pacemaker implantation.
• Standard electrocardiogram (ECG) may not detect all cases of atrial fibrillation.

Observation:

• Three patients with large-vessel occlusion underwent mechanical thrombectomy.
• Electrocardiogram (ECG) did not detect atrial fibrillation in these patients.
• Transesophageal echocardiography revealed characteristic left atrial appendage (LAA) movements and reduced blood flow velocity.

Findings:

• Transesophageal echocardiography identified left atrial appendage (LAA) abnormalities suggestive of atrial fibrillation.
• These findings indicate that LAA movements can be a marker for occult atrial fibrillation.
• The diagnostic utility of transesophageal echocardiography in detecting subtle atrial fibrillation is highlighted.

Implications:

• Transesophageal echocardiography may improve the diagnosis of new-onset atrial fibrillation in patients with stroke.
• This imaging technique offers a valuable tool for identifying atrial fibrillation when ECG is inconclusive.
• Enhanced detection of atrial fibrillation can lead to timely anticoagulation therapy and stroke prevention.