EDITORIALS
Stroke risk in the elderly: it’s not all about visible clot
Correspondence to:
Dr P Kanagaratnam, Department of Cardiology, St Mary’s Hospital, Praed St, London W2 1NY, UK; p.kanagaratnam@imperial.ac.uk
| The first 150 words of the full text of this article appear below. |
Transoesophageal echocardiography (TOE) has become an essential tool in the management of patients with atrial fibrillation (AF) by enabling safe early cardioversion and helping to prevent perioperative strokes during AF ablation procedures. Visualisation of left atrial appendage (LAA) thrombus remains key to the decision to proceed to cardioversion or ablation. The justification for this approach comes from a multicentre, randomised, prospective trial of patients (n = 1222) with AF of more than 2 days’ duration, assigned to early TOE-guided cardioversion or delayed cardioversion following conventional anticoagulation.1 The study found no difference in the composite primary end point (cerebrovascular accident, transient ischaemic attack and peripheral embolism) at 8 weeks between the two treatment options. However, the TOE group had fewer haemorrhagic complications, although there was an embolic event rate (0.5–0.8%) in both groups. By 8 weeks, there were no significant differences between the two groups in the rates of death, maintenance
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