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Europace Advance Access published online on May 10, 2006
Europace, doi:10.1093/europace/eul034
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© The European Society of Cardiology 2006. All rights reserved
Received February 15, 2005
Accepted February 24, 2006

Article

Clinical practicality and predictive value of transoesophageal echocardiography in early cardioversion of atrial fibrillation

Marjatta Strandberg 1, M.J. Pekka Raatikainen 2, Matti Niemelä 2, Matti Luotolahti 3, Jaakko Hartiala 3, and K.E. Juhani Airaksinen 1 *

1 Department of Internal Medicine, Division of Cardiology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
2 Department of Internal Medicine, Division of Cardiology, Oulu University Hospital, Oulu, Finland
3 Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland

* To whom correspondence should be addressed.
K.E. Juhani Airaksinen, E-mail: juhani.airaksinen{at}tyks.fi


  Abstract

Aims The objective of this study is to evaluate the feasibility of transoesophageal echocardiography (TOE)-guided cardioversion (CV) of atrial fibrillation (AF) in daily clinical practice.

Methods and results Transthoracic echocardiography and TOE were performed in 346 consecutive patients with AF lasting longer than 48 h or of unknown duration. If no intracavitary thrombus was found, CV was performed within 24 h of the TOE examination. Anticoagulation with subcutaneous low-molecular-weight heparin and warfarin was always started before CV. Warfarin was continued for at least 1 month after CV. The predictive value of several echocardiographic parameters including peak left atrial appendage emptying velocity (PLAAEV), left ventricular ejection fraction, left atrial diameter, and spontaneous echo contrast for the initial and long-term success of CV were evaluated. Transoesophageal echocardiography revealed no thrombus or other contraindications to CV in 274/346 (79%) patients. Early CV restored normal sinus rhythm or pacemaker rhythm in 90% (246/274) of the patients. One patient (0.3%) had a stroke within 30 days after CV. Peak left atrial appendage emptying velocity was significantly lower in patients with contraindications to early CV (P<0.001). However, neither PLAAEV nor any other echocardiographic parameter predicted the initial success of CV and the maintenance of sinus rhythm during long-term follow-up.

Conclusion Early TOE-guided CV with short-term anticoagulation is a safe and clinically effective alternative in treatment of AF lasting longer than 48 h or of unknown duration. The initial and long-term success of CV cannot be reliably predicted by echocardiographic parameters.

Keywords: Transoesophageal echocardiography; Atrial fibrillation; Thrombus; Cardioversion; Stroke.
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