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
- device closure
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
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.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.