Should transesophageal echocardiography be used to guide cardioversion?
Article Abstract:
It may be too soon to recommend that patients in atrial fibrillation undergo cardioversion without long-term anticoagulation if transesophageal echocardiography reveals no blood clots in the heart. When the heart is in atrial fibrillation, it may throw off a blood clot (embolus) that could travel to the brain, causing a stroke. Consequently, most patients are treated with long-term anticoagulants before their hearts are converted to normal rhythm. However, a 1993 study found that patients with atrial fibrillation could be safely converted without anticoagulation if transesophageal echocardiograms showed that their hearts were free of blood clots. Transesophageal echocardiography has risks and should be performed by surgeons who are skilled in its use. And it may miss small blood clots; one patient with a negative transesophageal echocardiogram who was not given anticoagulants suffered a stroke after cardioversion.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1993
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Cardioversion guided by transesophageal echocardiography: the ACUTE pilot study
Article Abstract:
Early screening for blood clots with transesophageal echocardiography (TEE) appears to be an effective and efficient way to plan further treatments for patients with an abnormal heart rhythm called atrial fibrillation. Successful restoration of a normal heart rhythm, later development of clots, and other circulatory conditions were evaluated among 126 patients screened with TEE or given conventional therapy to reduce clot formation. None of the patients given early shock treatment after a clear TEE developed clots. More patients screened with TEE had earlier and successful heart rhythm restoration.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1997
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Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation
Article Abstract:
Patients with atrial fibrillation can safely undergo defibrillation after a short dose of anticoagulants provided a transesophageal echocardiogram shows no blood clot in the heart. Defibrillation can cause blood clots to dislodge and travel to the brain, so most patients are treated with anticoagulants for three weeks to prevent blood clot formation.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 2001
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