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Should All Patients Undergo Transesophageal Echocardiography Before Electrical Cardioversion of Atrial Fibrillation

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Cardiac Arrhythmias 1995
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Abstract

Electrical cardioversion may be complicated by cerebral, systemic, and pulmonary embolic events in 0.6%–7% (1–3) of patients undergoing the procedure. Thromboembolism has been attributed to the dislodgment of preformed thrombus from the left atrium (LA) or left atrial appendage (LAA) with the resumption of sinus rhythm and atrial contraction (4).

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References

  1. Lown B (1967) Electrical reversion of cardiac arrhythmias. Br Heart J 29: 469–489

    Article  PubMed  CAS  Google Scholar 

  2. Grimm RA, Stewart W, Black IW et al (1994) Should all patients undergo transesophageal echocardiography before electrical cardioversion of atrial fibrillation? J Am Coll Cardiol 23: 533–541

    Article  PubMed  CAS  Google Scholar 

  3. Fatkin D, Kuchar DL, Thorburn CW et al (1994) Trans-esophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for “atrial stunning” as a mechanism of thromboembolic complications. J Am Coll Cardiol 23: 307–316

    Article  PubMed  CAS  Google Scholar 

  4. Mancini GBJ, Goldberger AL (1982) Cardioversion of atrial fibrillation: consideration of embolisation, anticoagulation, prophylactic pacemaker, and long-term success. Am Heart J 104: 612–621

    Article  Google Scholar 

  5. Merino A, Hamptman P, Badiman L et al (1992) Echocardiographic “smoke” is produced by interaction of erythrocytes and plasma proteins modulated by shear forces. J Am Coll Cardiol 20: 1661–1668

    Article  PubMed  CAS  Google Scholar 

  6. Daniel WG, Nellesen V, Schroder E et al (1988) Left atrial spontaneous contrast in mitral valve disease: an indicator for an increase thromboembolic risk. J Am Coll Cardiol 11: 1204–1211

    Article  PubMed  CAS  Google Scholar 

  7. Tsai LM, Chen JH, Fang CJ et al (1992) Clinical implication of left atrial spontaneous echocontrast in non-rheumatic atrial fibrillation. Am J Cardiol 70: 327–331

    Article  PubMed  CAS  Google Scholar 

  8. Black LW, Chesterman CN, Hopkins AP et al (1993) Hematologic correlates of left atrial spontaneous echo-contrast and thromboembolic in non valvular atrial fibrillation. J Am Coll Cardiol 21: 451–457

    Article  PubMed  CAS  Google Scholar 

  9. Pearson AC, Labovitz AJ, Tatinemi S et al (1991) Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol 17: 66–72

    Article  PubMed  CAS  Google Scholar 

  10. Cujec B, Mycyk T, Khovri M (1992) Identification of Chiari’s network with transesophageal echocardiography. J Am Soc Echocardiogr 5: 96–99

    PubMed  CAS  Google Scholar 

  11. Vandenbogaerde J, De Bleeker J, Decoo D et al (1992) Trans-esophageal echo-Doppler in patients suspected of a cardiac source of peripheral emboli. Eur Heart J 13: 88–94

    PubMed  CAS  Google Scholar 

  12. Derook FA, Comess KA, Albers GV et al (1992) Trans-esophageal echocardiography in the evaluation of stroke. Ann Intern Med 117: 992–932

    Google Scholar 

  13. Acar J, Cormier B, Grimbery D et al (1991) Diagnosis of left atrial thrombi in mitral stenosis, usefulness of ultrasound techniques compared with other methods. Eur Heart J 12 (Suppl B): 70–76

    PubMed  Google Scholar 

  14. Herroy CA, Bass D, Kane M et al (1984) Two dimensional echocardiographic imaging of the left atrial appendage trombus. J Am Coll Cardiol 1340–1344

    Google Scholar 

  15. Daniel WG, Angermann C, Englerding R et al (1989) Trans-esophageal echocardiography in patients with cerebral ischemic events and arterial embolism. A European multicenter study. Circulation 80 [Suppl 11] II: 473 (abstr)

    Google Scholar 

  16. Larandogoitia E, Medina A, Ortega JR et al (1991) Echo-transesofagico en la seleccion de los pacientes para valvuloplastica mitral percutanea. Estudio de 71 pacientes consecutivos. Rev Esp Cardiol 44: 599–604

    Google Scholar 

  17. Pollick C, Taylor D (1991) Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus. Circulation 84: 223–231

    PubMed  CAS  Google Scholar 

  18. Garcia-Fernander M, Torrecilla EG, San Roman D et al (1992) Left atrial appendage Doppler flow patterns: implications on thrombus formation. Am Heart J 124: 955–961

    Article  Google Scholar 

  19. Verhost PMJ, Kemp D, Visser CA et al (1993) Left atrial appendage flow velocity assessment using transesophageal echocardiography in nonrheumatic atrial fibrillation and systemic embolism. Am J Cardiol 71: 192–196

    Article  Google Scholar 

  20. Mügge A, Kühn H, Nikutta P et al (1994) Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk. J Am Coll Cardiol 23: 599–607

    Article  PubMed  Google Scholar 

  21. Black IW, Fatkin D, Sagar KB et al (1993) Does exclusion of atrial thrombus by transesophageal echocardiography preclude embolism after cardioversion? A multicenter study. Circulation 88 [Suppl 1] I: 314 (abstr)

    Google Scholar 

  22. Grimm RA, Stewart WJ, Maloney JD et al (1993) Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo-contrast: characterization by simultaneous transesophageal echocardiography. J Am Coll Cardiol 22:1359–1360

    Article  PubMed  CAS  Google Scholar 

  23. Manning WJ, Leeman DE, Gotch PJ et al (1989) Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation. J Am Coll Cardiol 13: 617–623

    Article  PubMed  CAS  Google Scholar 

  24. Shapiro EP, Effron MB, Lima S et al (1988) Transient atrial dysfunction after conversion of chronic atrial fibrillation to sinus rhythm. Am J Cardiol 1988; 62: 1202–1207

    Article  CAS  Google Scholar 

  25. Dethy M, Chassat C, Roy D et al (1988) Doppler echocardiographic predictors of recurrence of atrial fibrillation after cardioversion. Am J Cardiol 62: 723–726

    Article  PubMed  CAS  Google Scholar 

  26. Pop G, Sutherland GR, Kondstaal PJ et al (1990) Trans-esophageal echocardiography in the detection of intracardiac embolic sources in patients with ischemic attacks. Stroke 21: 560–561

    Article  PubMed  CAS  Google Scholar 

  27. Lee RJ, Bartzokis J, Yeah JK et al (1991) Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography. Stroke 22: 734–739

    Article  PubMed  CAS  Google Scholar 

  28. Doud DN, Jacobs WR, Moran JF et al (1990) The natural history of left ventricular spontaneous contrast. J Am Soc Echocardiogr 3: 465–470

    PubMed  CAS  Google Scholar 

  29. Weinberg DM, Mancini J (1989) Anticoagulation for cardioversion of atrial fibrillation. Am J Cardiol 15: 745–746

    Article  Google Scholar 

  30. Black IW, Hopkins AP, Lee LCL et al (1991) Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol 18: 398–404

    Article  PubMed  CAS  Google Scholar 

  31. Bjerkelund CJ, Orming OM (1969) The efficacy of anticoagulant therapy in preventing embolism related to DC electrical conversion of atrial fibrillation. Am J Cardiol 23: 208–216

    Article  PubMed  CAS  Google Scholar 

  32. Tsai LM, Hung JS, Chen JH (1991) Resolution of left atrial appendage thrombus in mitral stenosis after warfarin therapy. Am Heart J 121:1232–1234

    Article  PubMed  CAS  Google Scholar 

  33. Dunn M, Alexander J, de Silva R, Hildner F (1989) Antithrombotic therapy in atrial fibrillation. Chest 95: 118S–127S

    Article  PubMed  CAS  Google Scholar 

  34. Klein AL, Grimm RA, Black IW et al (1994) Cost effectiveness of TEE-guided cardioversion with anticoagulation compared to conventional therapy in patients with atrial fibrillation. J Am Coll Cardiol 23: 128A (abstr)

    Google Scholar 

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© 1996 Springer-Verlag Italia, Milano

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De Piccoli, B., Rigo, F., Ragazzo, M. (1996). Should All Patients Undergo Transesophageal Echocardiography Before Electrical Cardioversion of Atrial Fibrillation. In: Raviele, A. (eds) Cardiac Arrhythmias 1995. Springer, Milano. https://doi.org/10.1007/978-88-470-2223-2_41

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  • DOI: https://doi.org/10.1007/978-88-470-2223-2_41

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-3-540-75012-3

  • Online ISBN: 978-88-470-2223-2

  • eBook Packages: Springer Book Archive

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