Document Detail

Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. A multicenter study.
MedLine Citation:
PMID:  8205657     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Transesophageal echocardiography (TEE) has been used recently to detect atrial thrombi before cardioversion of atrial arrhythmias. It has been assumed that embolic events after cardioversion result from embolism of preexisting atrial thrombi that are accurately detected by TEE. This study examined the clinical and echocardiographic findings in patients with embolism after cardioversion of atrial fibrillation despite exclusion of atrial thrombi by TEE. METHODS AND RESULTS: Clinical and echocardiographic data in 17 patients with embolic events after TEE-guided electrical (n = 16) or pharmacological (n = 1) cardioversion were analyzed. All 17 patients had nonvalvular atrial fibrillation, including four patients with lone atrial fibrillation. TEE before cardioversion showed left atrial spontaneous echo contrast in five patients and did not show atrial thrombus in any patient. Cardioversion resulted in return to sinus rhythm without immediate complication in all patients. Thirteen patients had cerebral embolic events and four patients had peripheral embolism occurring 2 hours to 7 days after cardioversion. None of the patients were therapeutically anticoagulated at the time of embolism. New or increased left atrial spontaneous echo contrast was detected in four of the five patients undergoing repeat TEE after cardioversion including one patient with a new left atrial appendage thrombus. CONCLUSIONS: Embolism may occur after cardioversion of atrial fibrillation in inadequately anticoagulated patients despite apparent exclusion of preexisting atrial thrombus by TEE. These findings suggest de novo atrial thrombosis after cardioversion or imperfect sensitivity of TEE for atrial thrombi and suggest that screening by TEE does not obviate the requirement for anticoagulant therapy at the time of and after cardioversion. A randomized clinical trial is needed to compare conventional anticoagulant management with a TEE-guided strategy including anticoagulation after cardioversion.
I W Black; D Fatkin; K B Sagar; B K Khandheria; D Y Leung; J M Galloway; M P Feneley; W F Walsh; R A Grimm; C Stollberger
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Circulation     Volume:  89     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1994 Jun 
Date Detail:
Created Date:  1994-07-14     Completed Date:  1994-07-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2509-13     Citation Subset:  AIM; IM    
Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / therapy*,  ultrasonography
Echocardiography, Transesophageal*
Electric Countershock / adverse effects*
Middle Aged
Thromboembolism / etiology*,  ultrasonography
Comment In:
Circulation. 1994 Dec;90(6):3122   [PMID:  7994866 ]
Circulation. 1994 Dec;90(6):3121-2   [PMID:  7994865 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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