Document Detail

Use of transesophageal contrast echocardiography for excluding left atrial appendage thrombi in patients with atrial fibrillation before cardioversion.
MedLine Citation:
PMID:  12411914     Owner:  NLM     Status:  MEDLINE    
Transesophageal echocardiographic (TEE) guidance of cardioversion in patients with atrial fibrillation is an alternative method to conventional anticoagulation. Although TEE is considered the gold standard for excluding left atrial (LA) thrombi, in some patients dense spontaneous echo contrast (SEC) and artifacts may hamper the identification or exclusion of LA thrombi. Often those patients are refused cardioversion. The purpose of this study was to determine whether the application of echo contrast (Optison, Mallinckrodt, San Diego, Calif) facilitates the exclusion of LA appendage thrombi in this patient group and allows for safer cardioversion. Forty-one patients with atrial fibrillation and dense SEC or inconclusive TEE findings were given echo contrast. Fourteen patients with sinus rhythm served as control participants. Echo contrast completely reduced artifacts in 13 of 22 patients. In 12 of 19 patients with SEC, the LA appendage was completely filled after the application of echo contrast and, thus, SEC was completely suppressed. In 13 of 41 patients, it was filled incompletely and in 9 of 41 patients, a new mass resembling a thrombus was detected. In total, of 25 of 41 patients with inconclusive TEE findings an atrial thrombus was definitively excluded. Those patients underwent cardioversion. None of those patients had a cerebral embolic complication as assessed by cranial magnetic resonance imaging. Thus, the application of echo contrast may facilitate the TEE exclusion of LA appendage thrombi and, hence, improve the safety of TEE-guided cardioversion.
Giso von der Recke; Harald Schmidt; Stefan Illien; Berndt Lüderitz; Heyder Omran
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  15     ISSN:  0894-7317     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-11-04     Completed Date:  2003-02-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1256-61     Citation Subset:  IM    
Department of Medicine-Cardiology, University of Bonn, Germany.
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MeSH Terms
Anticoagulants / therapeutic use
Atrial Appendage / drug effects*,  physiopathology,  ultrasonography*
Atrial Fibrillation / physiopathology,  therapy*,  ultrasonography*
Blood Flow Velocity / physiology
Diagnosis, Differential
Echocardiography, Transesophageal*
Electric Countershock*
Follow-Up Studies
Heart Diseases / physiopathology,  therapy*,  ultrasonography*
Heparin / therapeutic use
Image Enhancement
Middle Aged
Prospective Studies
Stroke Volume / physiology
Thrombosis / physiopathology,  therapy*,  ultrasonography*
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin

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