Document Detail


Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation.
MedLine Citation:
PMID:  7754955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The role of TEE in the guidance of cardioversion of atrial fibrillation was studied. Thirty-seven (18%) of 206 patients had left atrial thrombus. Cardioversion was attempted in 153 patients receiving no (n = 107) or < 7 days (n = 46) of anticoagulation prophylaxis, in 27 patients after > or = 3 weeks of anticoagulation, and was cancelled in 26 patients, primarily on the basis of TEE findings. Left atrial thrombus was observed in 37 (18%) of 206 patients. No embolic complications occurred over a 4-week follow-up period. In 7 (41%) of 17 patients new left atrial appendage spontaneous echocardiographic contrast developed immediately after electric cardioversion. In this group, significant decreases occurred in the left atrial appendage maximal emptying shear rate (11.1 +/- 11.1 sec-1 vs 5.0 +/- 5.1 sec-1; p < 0.05), maximal filling shear rate (6.7 +/- 5.9 sec-1 vs 3.7 +/- 3.5 sec-1; p < 0.05), and peak emptying velocity (0.38 +/- 0.29 cm/sec vs 0.19 +/- 0.14 cm/sec; p < 0.05). In one patient a left atrial appendage thrombus formed after electric cardioversion. Left atrial thrombus resolved in 1 (5%) of 21 patients and became immobile in 0 (0%) of 16 patients after 3 to 5 weeks of anticoagulation but resolved (n = 9) or became immobile (n = 6) in 15 (71%) of 21 patients after > 5 weeks of anticoagulation. TEE-guided cardioversion was safely done without or with < 7 days of anticoagulation prophylaxis in selected patients, but the potential for left atrial thrombus to form after electric cardioversion makes anticoagulation advisable in all patients. The conventional recommendation of 3 to 4 weeks of anticoagulation prophylaxis before cardioversion is usually inadequate for left atrial thrombus to resolve or to become immobile.
Authors:
M F Stoddard; P R Dawkins; C R Prince; R A Longaker
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  129     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1995 Jun 
Date Detail:
Created Date:  1995-06-22     Completed Date:  1995-06-22     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1204-15     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, University of Louisville KY 40202, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anticoagulants / therapeutic use
Atrial Fibrillation / therapy*,  ultrasonography
Atrial Function, Left
Blood Flow Velocity
Cardiac Output
Echocardiography, Transesophageal*
Electric Countershock*
Female
Follow-Up Studies
Heart Atria / ultrasonography
Heart Diseases / drug therapy,  ultrasonography
Humans
Male
Middle Aged
Thrombosis / drug therapy,  ultrasonography
Time Factors
Treatment Outcome
Ultrasonography, Interventional*
Chemical
Reg. No./Substance:
0/Anticoagulants

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


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