Journal of the American Society of Echocardiography
Original ArticlesUse of transesophageal contrast echocardiography for excluding left atrial appendage thrombi in patients with atrial fibrillation before cardioversion☆
Section snippets
Study patients
The study was conducted as a prospective study at a tertiary cardiac referral center. Between January 1999 and September 2000, 121 patients underwent TEE for the exclusion of LA thrombi before cardioversion. In 41 of 121 patients exclusion of LA appendage thrombi was difficult because of either dense SEC (n = 19) or artifacts in the LA appendage (n = 22). Those patients formed the study group and were investigated by contrast TEE to evaluate the use of echo contrast on excluding LA appendage
Patients
During the study period, 121 patients underwent TEE for the exclusion of LA appendage thrombi before cardioversion. Sixty-six patients (55%) had previous cardioversion attempts, 75 patients (61%) had a duration of AF more than 3 months. In 13 of the 121 patients (11%), a LA appendage thrombus was identified. In 41 patients (34%; 33 men, age: 66.2 ± 9.5 years old), ambiguous findings lead to inclusion in the study group. Of those, 23 patients had coronary artery disease, 7 patients had a
Discussion
TEE-guided cardioversion of AF is an alternative approach to conventional anticoagulation. However, a potential clinical problem is the definitive exclusion of LA thrombi in patients with dense SEC or in patients with artifacts in the LA appendage. This is the first study to investigate the use of echo contrast for excluding LA appendage thrombi in patients with AF scheduled for cardioversion. The results of our study show that the application of intravenous echo contrast during the TEE study
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Reprint requests: Heyder Omran, MD, Department of Medicine - Cardiology, University of Bonn, Sigmund-Freud-Str. 25, D 53105 Bonn, Germany (E-mail: [email protected]).