Document Detail

Is transesophageal echocardiography necessary before D.C. cardioversion in patients with a normal transthoracic echocardiogram?
MedLine Citation:
PMID:  17381649     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Transesophageal echocardiography has emerged as an accepted approach before D.C. cardioversion for atrial fibrillation. The frequency of atrial thrombi detected on transesophageal echocardiography has varied from 7% to 23%. Many patients undergoing transesophageal echocardiography have had a previous transthoracic echocardiogram. Though transthoracic echocardiography has a low yield for the detection of intracardiac thrombi, it is highly accurate in diagnosing a structurally abnormal heart. The purpose of this study was to assess the frequency of thrombi detected by transesophageal echocardiography in patients with an entirely normal transthoracic echocardiogram and hence the advocacy of a selective approach in performing transesophageal echocardiography in patients undergoing D.C. cardioversion for atrial fibrillation. METHODS: 112 consecutive patients with atrial fibrillation who had undergone transesophageal echocardiography before D.C. cardioversion were evaluated. They all had a transthoracic echocardiogram within the 2 months preceding their transesophageal echocardiogram. Based on their transthoracic echocardiographic study, they were divided into two groups: Group 1 consisted of patients with a normal transthoracic echocardiogram and Group 2, those with an abnormal study. RESULTS: Thrombi or spontaneous echo contrast were found in 14 of 112 patients (16%). All however were detected in Group 2 patients. There was no patient with a normal transthoracic echocardiogram who had thrombus on his/her transesophageal echocardiogram. CONCLUSIONS: Our results suggest that a selective approach may be exercised in the use of transesophageal echocardiography prior to D.C. cardioversion for atrial fibrillation. Patients with an entirely "normal" transthoracic echocardiogram may proceed directly to cardioversion without a precardioversion transesophageal echocardiogram.
Mohsen Sharifi; Alireza Parhizgar; Punam Gupta; Mahshid Mehdipour; Farnaz Emrani; David Baldwin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  24     ISSN:  0742-2822     ISO Abbreviation:  Echocardiography     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-08-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  United States    
Other Details:
Languages:  eng     Pagination:  397-400     Citation Subset:  IM    
Section of Cardiology, Department of Medicine, Texas Tech University Health Sciences Center and Medical Center Hospital, 701 W. 5th Street, Odessa, Texas, USA.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / physiopathology,  therapy*,  ultrasonography*
Atrial Function
Case-Control Studies
Echocardiography, Transesophageal
Electric Countershock*
Hyperthyroidism / ultrasonography
Middle Aged
Observer Variation
Research Design
Retrospective Studies
Thrombosis / epidemiology,  physiopathology,  ultrasonography
Treatment Outcome

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

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