Saeed Mohammad, Rahman Atiar, Afzal Adeel, Agoston Ildiko, Jammula Praveen, Birnbaum Yochai, Ware David L, Uretsky Barry F, Schwarz Ernst R, Rosanio Salvatore
The Department of Internal Medicine, Division of Cardiology, The University of Texas Medical Branch, Galveston, Texas 77555-0553, United States.
Int J Cardiol. 2006 Nov 18;113(3):401-5. doi: 10.1016/j.ijcard.2006.03.036. Epub 2006 Jul 5.
The value of transesophageal echocardiography (TEE) to prevent cardioversion-related thromboembolic events in patients with atrial fibrillation (AF) and left atrial (LA) thrombus is unclear. We compared the embolic risk associated with a strategy of follow-up TEE-guided direct-current cardioversion (DCCV) with that of blind DCCV in patients with AF, pre-existing LA thrombus and effective anticoagulation.
We identified 67 subjects with TEE-documented LA appendage thrombi from a total of 520 consecutive patients with symptomatic non-rheumatic AF who were referred to us for elective DCCV. All patients received at least 4 weeks of effective warfarin therapy (target international normalized ratio, 2 to 3) before and after DCCV. At time of DCCV, 20 patients had TEE and 47 did not. There were no clinical and echocardiographic differences between the two groups. Thrombus resolution was documented in 18 (90%) patients. After a median follow-up of 4 weeks, two transient ischemic attacks were observed in patients who were blindly cardioverted and one in patients belonging to the TEE group. Sinus rhythm was documented at the time of each thromboembolic event. By multiple logistic regression analysis the TEE strategy was not associated with lower risk of thromboembolism as compared to blind DCCV (odds ratio 1.37; 95% confidence interval, 0.16% to 15.86%; p=0.20).
In patients with AF, LA thrombus and effective anticoagulation, there is no difference in the risk of clinical thromboembolism between DCCV with or without follow-up TEE. Benefits of warfarin are related to thrombus resolution and prevention of new thrombus formation.
经食管超声心动图(TEE)在预防心房颤动(AF)合并左心房(LA)血栓患者心脏复律相关血栓栓塞事件中的价值尚不清楚。我们比较了AF、存在LA血栓且接受有效抗凝治疗的患者,采用随访TEE引导下直流电复律(DCCV)策略与盲目DCCV的栓塞风险。
我们从520例因症状性非风湿性AF前来接受择期DCCV的连续患者中,识别出67例经TEE证实有LA附件血栓的受试者。所有患者在DCCV前后均接受至少4周的有效华法林治疗(目标国际标准化比值为2至3)。在DCCV时,20例患者接受了TEE检查,47例未接受。两组之间在临床和超声心动图方面无差异。18例(90%)患者血栓溶解。中位随访4周后,盲目复律的患者中观察到2例短暂性脑缺血发作,TEE组有1例。每次血栓栓塞事件发生时均记录到窦性心律。通过多因素逻辑回归分析,与盲目DCCV相比,TEE策略与较低的血栓栓塞风险无关(优势比1.37;95%置信区间,0.16%至15.86%;p = 0.20)。
在AF、LA血栓且接受有效抗凝治疗的患者中,有或无随访TEE的DCCV在临床血栓栓塞风险方面无差异。华法林的益处与血栓溶解及预防新血栓形成有关。