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Original research
Impact of ultrasound contrast agent on the detection of thrombi during transoesophageal echocardiography
  1. Henning Ebelt,
  2. Alexandra Offhaus,
  3. Matthias Wiora,
  4. Peter Roehl,
  5. Andreas Schwenzky,
  6. Anja Weida,
  7. Matthias Hoyme,
  8. Juliane Bindemann-Koecher and
  9. Jelena Anacker
  1. Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
  1. Correspondence to Dr Henning Ebelt; henningebelt{at}


Background Atrial fibrillation (AF) carries the risk of thrombus formation in the left atrium and especially in the left atrial appendage (LAA). A transoesophageal echocardiography (TOE) is routinely performed in these patients to rule out thrombi before cardioversion or structural interventions like LAA closure or pulmonary vein isolation. However, in a certain number of cases, inconclusive results of the TOE may result. This study was performed to analyse whether the routine use of ultrasound contrast agent (UCA) has an influence on the frequency of thrombus detection.

Methods In patients with AF who were scheduled for a subsequent interventional procedure, a TOE was initially performed without contrast agent. Then, the TOE was repeated with the use of UCA. The percentage of diagnostic findings regarding the prevalence of thrombus in the LAA with and without UCA were compared (thrombus present (T+), no thrombus (T−) and inconclusive result (T+/−)).

Results 223 patients were prospectively included into the trial. The numbers of thrombus detection were as follows: without UCA: 17 T+ (7.6%), 154 T− (69.1%), 52 T+/− (23,3%); with UCA: 16 T+ (7.2%), 179 T− (80.3%), 28 T+/− (12.6%; χ2: p<0.01). In 29 examinations (13.0%), the use of UCA had an impact on the subsequent treatment strategy.

Conclusions The use of UCA during TOE in patients with AF has a significant impact on the subsequent patient management especially due to an improved rule out of LAA thrombi.

  • atrial fibrillation
  • transoesophageal
  • device closure

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  • Contributors All authors have contributed to the final manuscript. HE: planning and conduct of the study, writing of the manuscript and responsible for the overall content. AO: planning and conduct of the study and manuscript revision. MW, PR, AS, JB-K and MH: conduct of the study and manuscript revision. AW: conduct of the study and data acquisition. JA: conduct of the study, manuscript revision and data acquisition.

  • Funding This study was partially supported by a grant from Boston Scientific (Investigator Sponsored Research).

  • Competing interests HE has received honoraria for lectures from Bayer, Novartis, Pfizer, Boehringer Ingelheim and Boston Scientific. This study was partially supported by a grant from Boston Scientific (Investigator Sponsored Research).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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