Value of transesophageal echocardiography in atrial fibrillation

ABSTRACT

A total of 40 patients [25 females and 15 males], mean age 39 years +/- 12 with atrial fibrillation [AF] duration more than two days who were not on anticoagulation therapy were randomized to either TEE guided anticoagulation followed by cardioversion or to conventional arm which include transthoracic echocardiography and three weeks of anticoagulation followed by cardioversion. A further four weeks of oral anticoagulation therapy is continued and another four weeks follow up. Left atrium was dilated in all patients; 5.1 cm +/- 0.6 left atrial thrombi were detected by TEE in seven cases. Spontaneous echo contrast sign was detected in 63% of patients in the TEE arm of the study. The incidence of mitral incompetence was significantly higher in patients without left arterial thrombi. There was one death during the follow up period due to thromboembolic complications and no other embolic events in either groups could be detected. The results suggested that TEE guided approach is as safe as the conventional method, more convenient and lessen the need of prolonged use of anticoagulation