Document Detail


Transesophageal echocardiography (TEE) in atrial fibrillation.
MedLine Citation:
PMID:  11236168     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Transesophageal echocardiography has given new insight into the pathogenesis of the thromboembolic sequelae of AF and expanded the available therapeutic options. Studies to date indicate that TEE-guided cardioversion is a safe and reasonable approach when the clinical situation warrants prompt restoration of sinus rhythm. Whether widespread use of this strategy offers further benefit remains to be established, although there are theoretical advantages to such an approach. The potential for earlier cardioversion using a TEE-guided approach may facilitate the achievement and maintenance of sinus rhythm. In the long term, earlier restoration of sinus rhythm prevents adverse atrial remodeling, lowers embolic risk, and may improve cardiac performance and functional status. Thromboembolic sequelae (either cardioversion-related or as a result of chronic AF) remain the most devastating complications of AF. Every attempt to minimize this risk should be pursued aggressively. Information gathered from TEE has helped to elucidate the mechanisms responsible for postcardioversion embolism and has emphasized the importance of anticoagulation during and after the restoration of sinus rhythm. TEE also has the potential to further risk stratify patients with AF. Ultimately, a subset of patients may be identified who require more intense anticoagulation (i.e., those with dense SEC or thrombus, or persistent thrombus after prolonged anticoagulation) or in whom cardioversion may be deferred entirely. Likewise, TEE also may prove to be useful in identifying patients with a low-clinical risk profile who may be treated with aspirin alone and patients in whom warfarin may be superior. The results of the ACUTE study should help to further define the role of TEE in the management of patients with AF. Additional clinical studies are needed to address some of the issues that have been raised and to allow for optimal use of TEE in this patient population.
Authors:
M Thamilarasan; A L Klein
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiology clinics     Volume:  18     ISSN:  0733-8651     ISO Abbreviation:  Cardiol Clin     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2001-03-09     Completed Date:  2001-05-17     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8300331     Medline TA:  Cardiol Clin     Country:  United States    
Other Details:
Languages:  eng     Pagination:  819-31     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / therapy*,  ultrasonography*
Echocardiography, Transesophageal*
Electric Countershock* / adverse effects
Heart Atria / ultrasonography
Humans
Myocardial Stunning / etiology
Risk Assessment

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


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