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The role of echocardiography in atrial fibrillation and cardioversion
  1. Richard W Troughton1,
  2. Craig R Asher2,
  3. Allan L Klein2
  1. 1Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
  2. 2Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, Ohio, USA
  1. Correspondence to:
    Allan L Klein MD
    Cleveland Clinic Foundation, Department of Cardiovascular Medicine, 9500 Euclid Avenue, Desk F15, Cleveland, OH 44195, USA;

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Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice.1 Recent advances in technology and in the understanding of the pathophysiology of AF have led to more definitive and potentially curative therapeutic approaches.1 In this setting, echocardiography has a unique and important role in the assessment of cardiac structure and function, risk stratification, and increasingly in guiding the management of AF. Because of its recognised value, echocardiography has become established in guidelines for management of AF2 and utilisation of echocardiography has increased, particularly of transoesophageal echocardiography to guide direct current cardioversion or detect cardiac sources of embolism. Even more recently the development of intracardiac echocardiography has led to real-time guidance of percutaneous interventions, including radiofrequency ablation and left atrial appendage closure procedures for patients with AF.

In this review, we highlight the echocardiographic modalities that are available and their role in the evaluation and management of AF.


AF affects approximately 0.4% of the general population and its prevalence is increasing.3,4 AF frequently accompanies common conditions such as hypertension, chronic heart failure, and valvar or ischaemic heart disease, and is an important sequela of cardiothoracic surgery.5 Importantly, AF is associated with significant mortality and morbidity, particularly from thromboembolic stroke.3,6–9 The risk of stroke is greater in the elderly and with concomitant valvar (particularly rheumatic) heart disease; however, non-valvar AF is responsible for 75 000 strokes and hospitalisation costs of $1 billion dollars annually in the USA.10 In addition, AF may be associated with reduced functional capacity and impaired cardiac performance, particularly when ventricular rates are not adequately controlled.

Despite a mounting disease burden, there have been significant advances in the management of AF because of a greater mechanistic understanding of pathophysiology.1 The aetiology of AF is complex and …

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  • Conflict of interest statement: Dr Klein has a research grant from Aventis. There are no financial or personal associations that may pose a conflict of interest in connection with the submitted article for any of the other authors to disclose.

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