Usefulness of transoesophageal echocardiography prior to cardioversion in patients with atrial fibrillation and different anticoagulant therapies

Anna Maltagliati ^1*, Claudia Agnese Galli ¹, Gloria Tamborini ¹, Alfreda Ida Calligaris ¹, Elisabetta Doria ¹, Rezvanieh Salehi ² and Mauro Pepi ¹

¹ IRCCS, Italy
² University of Tabriz, Iran, Islamic Republic of

^* To whom correspondence should be addressed. E-mail: anna.maltagliati{at}ccfm.it.

Accepted 28 October 2005

Abstract

Objectives: To evaluate the prevalence of atrial thrombi in patients with atrial fibrillation and different anticoagulation regimens prior to cardioversion (CV). To evaluate the usefulness of transoesophageal (TOE) guided cardioversion to prevent thromboembolic complications. To correlate the presence of atrial thrombi to clinical and echocardiographic data.

Methods: Seven-hundred fifty-seven consecutive patients admitted to our hospital because candidates to CV of atrial fibrillation were enrolled in the study. They were divided into four groups: effective conventional oral anticoagulation, short-term anticoagulation, ineffective oral anticoagulation or subtherapeutic anticoagulation, effective oral anticoagulation with a duration of < 3 weeks for different clinical reasons. In all cases a TOE prior to CV was performed; in the presence of atrial thrombi or extreme left atrial echo contrast CV was postponed. The incidence of thromboembolic events were evaluated after CV.

Results: Atrial thrombi were detected in 48 out of 757 (6.3%) patients. No significant differences in the percentage of atrial thrombosis were found in the 4 study groups. Patients with atrial thrombosis were older, included a higher percentage of mitral prosthetic valves, had lower left ventricular ejection fraction, more severe atrial spontaneous echo contrast and lower values of Doppler left atrial appendage velocities. Six- hundred forty eight patients were scheduled for CV. CV was successful in 89% of cases without any major thromboembolic event.

Conclusions: The prevalence of atrial thrombosis before CV despite different anticoagulant therapies is approximately 7% and a TOE-guided approach may prevent the risk of embolic events.

Keywords: atrial thrombosis, atrial fibrillation, transoesophageal echocardiography

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