Halbfass P, Plewan A, Dennig K, Kolb C, Schmitt C
Städtisches Klinikum München-Bogenhausen I. Medizinische Abteilung, Englschalkinger Str. 77, 81925 München, Germany.
Herzschrittmacherther Elektrophysiol. 2006 Sep;17(3):127-32. doi: 10.1007/s00399-006-0523-z.
A total of 332 patients (mean age 65+/-10 years, 86 female) with nonvalvular atrial fibrillation (AF) of more than 48 hours duration and lack of a sufficient anticoagulation were included. After exclusion of thrombotic material in the left atrium using transesophageal echocardiography (TEE) cardioversion (CV) was performed within 24 hours. At the same time oral anticoagulation (AC) (overlapping with PTT-affecting heparinisation) was started. If thrombi were found by TEE, the examination was repeated after at least four weeks of anticoagulation. If thrombi were absent at this time, CV was performed. Periprocedural embolism was defined as primary endpoint, whereas the detection of atrial thrombi before CV was defined as secondary endpoint. In 33 of the 332 Patients (9.9%) the TEE showed a thrombus in the left atrium respectively the left atrial appendage (n=22) or thrombi could not be excluded (n=11). 383 TEEs were performed without complications in an overall of 332 patients.A total of 305 CV were performed (electrical n=300, pharmacological n=5) and during periprocedural monitoring and in the time of four weeks after CV no thromboembolic complications were observed.TEE-guided CV in patients with AF persisting for more than 48 hours and without previous AC can be considered as a method that is both safe and effective.
