From the Cardiology Division of the John Dempsey Hospital and University
of Connecticut Health Center, Farmington (D.I.S.), and the Charles A. Dana
Research Institute and the Harvard-Thorndike Laboratory of the Department of
Medicine, Cardiovascular Division (Department of Medicine) and Department of
Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, Mass (W.J.M.).
Abstract
Abstract—Echocardiography
has emerged as a fundamental tool in the evaluation of patients with
atrial fibrillation (AF). Transthoracic
echocardiography remains a primary tool for the
evaluation and management of many patients presenting with their
first episode of AF, but it is not adequate for exclusion of atrial
thrombi. TEE offers excellent visualization of the atria and accurate
identification or exclusion of thrombi. In concert with therapeutic
anticoagulation, a TEE-guided approach to early cardioversion appears
to have a safety profile similar to that of conventional therapy (1
month of precardioversion warfarin). The TEE-guided approach offers the
advantages of simplified anticoagulation management and shorter
duration of sustained AF, thereby allowing for a more rapid recovery of
atrial mechanical function. Warfarin should be continued for 1 month
after cardioversion to allow for more complete recovery of atrial
function and for prophylaxis should the patient revert to AF.
Cost-effectiveness models demonstrate that TEE-guided cardioversion
represents a cost-effective strategy, but only if the
transthoracic echocardiogram is omitted. For patients with
a thrombus on the initial TEE, follow-up TEE (to document thrombus
resolution) is recommended before cardioversion.
© 1998 American Heart Association, Inc.
Current Perspective
Role of Echocardiography in Patients Undergoing Elective Cardioversion of Atrial Fibrillation
Key Words: fibrillation • echocardiography • cardioversion • anticoagulants • atrial flutter
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