The American Journal of Medicine
Volume 113, Issue 7 , Pages 587-595 , November 2002

Critical appraisal of transesophageal echocardiography in cardioversion of atrial fibrillation

  • Joseph F Malouf, MD

      Affiliations

    • Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
    • Corresponding Author InformationRequests for reprints should be addressed to Joseph F. Malouf, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
    • ,
  • Naser M Ammash, MD

      Affiliations

    • Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
    • ,
  • Krishnaswamy Chandrasekaran, MD

      Affiliations

    • Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
    • ,
  • Paul A Friedman, MD

      Affiliations

    • Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
    • ,
  • Bijoy K Khandheria, MD

      Affiliations

    • Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
    • ,
  • Bernard J Gersh, MBChB, DPhil

      Affiliations

    • Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA

Received 11 February 2002 ,Accepted 5 August 2002.

References 

  1. Bjerkelund CJ, Orning OM. The efficacy of anticoagulant therapy in preventing embolism related to D.C. electrical conversion of atrial fibrillation. Am J Cardiol. 1969;23:208–216
  2. Redfield MM, Kay GN, Jenkins LS, et al.  Tachycardia-related cardiomyopathy (a common cause of ventricular dysfunction in patients with atrial fibrillation referred for atrioventricular ablation). Mayo Clin Proc. 2000;75:790–795
  3. Manning WJ, Silverman DI, Keighley CS, et al.  Transesophageal echocardiographically facilitated early cardioversion from atrial fibrillation using short-term anticoagulation (final results of a prospective 4.5-year study). J Am Coll Cardiol. 1995;25:1354–1361
  4. Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92:1954–1968
  5. Klein AL, Murray RD, Grimm RA. Role of transesophageal echocardiography–guided cardioversion of patients with atrial fibrillation. J Am Coll Cardiol. 2001;37:691–704
  6. Manning WJ, Silverman DI, Gordon SP, et al.  Cardioversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude the presence of atrial thrombi. N Engl J Med. 1993;328:750–755
  7. Murray RD, Goodman AS, Lieber EA, et al.  National use of the transesophageal echocardiographic–guided approach to cardioversion for patients in atrial fibrillation. Am J Cardiol. 2000;85:239–244
  8. Grimm RA, Stewart WJ, Maloney JD, et al.  Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast (characterization by simultaneous transesophageal echocardiography). J Am Coll Cardiol. 1993;22:1359–1366
  9. Fatkin D, Kuchar DL, Thorburn CW, Feneley MP. Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation (evidence for “atrial stunning” as a mechanism of thromboembolic complications). J Am Coll Cardiol. 1994;23:307–316
  10. Silverman DI, Manning WJ. Role of echocardiography in patients undergoing elective cardioversion of atrial fibrillation. Circulation. 1998;98:479–486
  11. Louie EK, Liu D, Reynertson SI, et al.  “Stunning” of the left atrium after spontaneous conversion of atrial fibrillation to sinus rhythm (demonstration by transesophageal Doppler techniques in a canine model). J Am Coll Cardiol. 1998;32:2081–2086
  12. Omran H, Jung W, Rabahieh R, et al.  Left atrial chamber and appendage function after internal atrial defibrillation (a prospective and serial transesophageal echocardiographic study). J Am Coll Cardiol. 1997;29:131–138
  13. Mattioli AV, Castelli A, Andria A, Mattioli G. Clinical and echocardiographic features influencing recovery of atrial function after cardioversion of atrial fibrillation. Am J Cardiol. 1998;82:1368–1371
  14. Mazzone C, Pandullo C, Scardi S, et al.  Left atrial and appendage mechanical function after pharmacological or electrical cardioversion in patients with chronic atrial fibrillation (a multicenter, randomized study). Ital Heart J. 2000;1:128–136
  15. Harjai K, Mobarek S, Abi-Samra F, et al.  Mechanical dysfunction of the left atrium and the left atrial appendage following cardioversion of atrial fibrillation and its relation to total electrical energy used for cardioversion. Am J Cardiol. 1998;81:1125–1129
  16. Weigner MJ, Caulfield TA, Danias PG, et al.  Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Ann Intern Med. 1997;126:615–620
  17. Falcone RA, Morady F, Armstrong WF. Transesophageal echocardiographic evaluation of left atrial appendage function and spontaneous contrast formation after chemical or electrical cardioversion of atrial fibrillation. Am J Cardiol. 1996;78:435–439
  18. Manning WJ, Silverman DI, Katz SE, et al.  Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm. Am J Cardiol. 1995;75:624–626
  19. Antonielli E, Pizzuti A, Bassignana A, et al.  Transesophageal echocardiographic evidence of more pronounced left atrial stunning after chemical (propafenone) rather than electrical attempts at cardioversion from atrial fibrillation. Am J Cardiol. 1999;84:1092–1096
  20. Sparks PB, Jayaprakash S, Mond HG, et al.  Left atrial mechanical function after brief duration atrial fibrillation. J Am Coll Cardiol. 1999;33:342–349
  21. Berger M, Schweitzer P. Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter (a retrospective analysis). Am J Cardiol. 1998;82:1545–1547
  22. Corrado G, Tadeo G, Beretta S, et al.  Atrial thrombi resolution after prolonged anticoagulation in patients with atrial fibrillation. Chest. 1999;115:140–143
  23. Weigner MJ, Thomas LR, Patel U, et al.  Early cardioversion of atrial fibrillation facilitated by transesophageal echocardiography (short-term safety and impact on maintenance of sinus rhythm at 1 year). Am J Med. 2001;110:694–702
  24. Stoddard MF, Dawkins PR, Prince CR, Longaker RA. Transesophageal echocardiographic guidance of cardioversion in patients with atrial fibrillation. Am Heart J. 1995;129:1204–1215
  25. Klein AL, Grimm RA, Murray RD, et al.  Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med. 2001;344:1411–1420
  26. Roijer A, Eskilsson J, Olsson B. Transoesophageal echocardiography–guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion. Eur Heart J. 2000;21:837–847
  27. Seidl K, Rameken M, Drogemuller A, et al.  Embolic events in patients with atrial fibrillation and effective anticoagulation (value of transesophageal echocardiography to guide direct-current cardioversion. Final results of the Ludwigshafen Observational Cardioversion Study). J Am Coll Cardiol. 2002;39:1436–1442
  28. Black IW, Fatkin D, Sagar KB, et al.  Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. A multicenter study. Circulation. 1994;89:2509–2513
  29. Moreyra E, Finkelhor RS, Cebul RD. Limitations of transesophageal echocardiography in the risk assessment of patients before nonanticoagulated cardioversion from atrial fibrillation and flutter (an analysis of pooled trials). Am Heart J. 1995;129:71–75
  30. Gentile F, Elhendy A, Khandheria BK, et al.  Safety of electrical cardioversion in patients with atrial fibrillation. Mayo Clin Proc. 2002;77:897–904
  31. Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin (incidence and prediction by factors known at the start of outpatient therapy). Am J Med. 1989;87:144–152
  32. Gersh BJ. Antithrombotic therapy in nonrheumatic/nonvalvular atrial fibrillation. J Cardiovasc Electrophysiol. 1999;10:461–471
  33. Dudley N, Berry C, McMurray J. Anticoagulation for patients with atrial fibrillation (warfarin should be given for up to one year after successful cardioversion). BMJ. 2000;321:638–639
  34. Samsa GP, Matchar DB, Goldstein LB, et al.  Quality of anticoagulation management among patients with atrial fibrillation (results of a review of medical records from 2 communities). Arch Intern Med. 2000;160:967–973
  35. Beyth RJ, Quinn LM, Landefeld CS. Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin. Am J Med. 1998;105:91–99
  36. Kim MH, Krishnan K, Jain S, Decena BF. Time course and frequency of subtherapeutic anticoagulation for newly prescribed warfarin anticoagulation before elective cardioversion of atrial fibrillation or flutter. Am J Cardiol. 2001;88:1428–1431
  37. Seto TB, Taira DA, Tsevat J, Manning WJ. Cost-effectiveness of transesophageal echocardiographic-guided cardioversion (a decision analytic model for patients admitted to the hospital with atrial fibrillation). J Am Coll Cardiol. 1997;29:122–130
  38. Seto TB, Taira DA, Manning WJ. Cardioversion in patients with atrial fibrillation and left atrial thrombi on initial transesophageal echocardiography (should transesophageal echocardiography be repeated before elective cardioversion? A cost-effectiveness analysis). J Am Soc Echocardiogr. 1999;12:508–516
  39. Veinot JP, Harrity PJ, Gentile F, et al.  Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts (implications for echocardiographic examination). Circulation. 1997;96:3112–3115
  40. Proceedings of the American College of Chest Physicians 5th Consensus on Antithrombotic Therapy, 1998. Chest. 1998;114(suppl):439S–769S
  41. Stoddard MF, Dawkins PR, Prince CR, Ammash NM. Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event (a transesophageal echocardiographic study). J Am Coll Cardiol. 1995;25:452–459
  42. Weitz JI. Low-molecular-weight heparins. N Engl J Med. 1997;337:688–698
  43. Gurfinkel EP, Manos EJ, Mejail RI, et al.  Low molecular weight heparin versus regular heparin or aspirin in the treatment of unstable angina and silent ischemia. J Am Coll Cardiol. 1995;26:313–318
  44. Fragmin During Instability in Coronary Artery Disease (FRISC) Study Group . Low-molecular-weight heparin during instability in coronary artery disease. Lancet. 1996;347:561–568
  45. Klein W, Buchwald A, Hillis SE, et al.  Comparison of low-molecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in Unstable Coronary Artery Disease Study (FRIC). Circulation. 1997;96:61–68
  46. Cohen M, Demers C, Gurfinkel EP, et al.  A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl J Med. 1997;337:447–452
  47. Levine M, Gent M, Hirsh J, et al.  A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med. 1996;334:677–681
  48. Koopman MM, Prandoni P, Piovella F, et al.  Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. N Engl J Med. 1996;334:682–687
  49. Kontny F, Dale J, Abildgaard U, Pedersen TR. Randomized trial of low molecular weight heparin (dalteparin) in prevention of left ventricular thrombus formation and arterial embolism after acute anterior myocardial infarction (the Fragmin in Acute Myocardial Infarction (FRAMI) Study). J Am Coll Cardiol. 1997;30:962–969
  50. Harenberg J, Weuster B, Pfitzer M, et al.  Prophylaxis of embolic events in patients with atrial fibrillation using low molecular weight heparin. Semin Thromb Hemost. 1993;19:116–121
  51. Murray RD, Shah A, Jasper SE, et al.  Transesophageal echocardiography guided enoxaparin antithrombotic strategy for cardioversion of atrial fibrillation (the ACUTE II Pilot Study). Am Heart J. 2000;139:1–7
  52. Murray RD, Deitcher SR, Shah A, et al.  Potential clinical efficacy and cost benefit of a transesophageal echocardiography-guided low-molecular-weight heparin (enoxaparin) approach to antithrombotic therapy in patients undergoing immediate cardioversion from atrial fibrillation. J Am Soc Echocardiogr. 2001;14:200–208
  53. Stellbrink C, Hanrath P, Nixdorff U, et al.  Low molecular weight heparin for prevention of thromboembolic complications in cardioversion—rationale and design of the ACE study (Anticoagulation in Cardioversion using Enoxaparin). [in German] Z Kardiol. 2002;91:249–254
  54. Tieleman RG, Van Gelder IC, Crijns HJ, et al.  Early recurrences of atrial fibrillation after electrical cardioversion (a result of fibrillation-induced electrical remodeling of the atria?). J Am Coll Cardiol. 1998;31:167–173
  55. Verhorst PM, Kamp O, Welling RC, et al.  Transesophageal echocardiographic predictors for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. Am J Cardiol. 1997;79:1355–1359
  56. Hobbs WJ, Fynn S, Todd DM, et al.  Reversal of atrial electrical remodeling after cardioversion of persistent atrial fibrillation in humans. Circulation. 2000;101:1145–1151
  57. Pandozi C, Santini M. Update on atrial remodelling owing to rate; does atrial fibrillation always ‘beget’ atrial fibrillation?. Eur Heart J. 2001;22:541–553
  58. Tanabe K, Yoshitomi H, Asanuma T, et al.  Prediction of outcome of electrical cardioversion by left atrial appendage flow velocities in atrial fibrillation. Jpn Circ J. 1997;61:19–24
  59. Antonielli E, Pizzuti A, Pálinkás A, et al.  Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. J Am Coll Cardiol. 2002;39:1443–1449
  60. Weigner MJ, Katz SE, Douglas PS, Manning WJ. Left atrial appendage anatomy and function (short term response to sustained atrial fibrillation). Heart. 1999;82:555–558

PII: S0002-9343(02)01318-9

The American Journal of Medicine
Volume 113, Issue 7 , Pages 587-595 , November 2002

Article Tools

* Image Usage & Resolution