Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Ludwigshafen, Germany.
J Am Soc Echocardiogr. 2009 Dec;22(12):1403-8. doi: 10.1016/j.echo.2009.09.015. Epub 2009 Oct 31.
The aim of this study was to investigate the value of transesophageal echocardiography (TEE)-guided cardioversion (CV) to prevent thromboembolic complications in patients with short-term atrial fibrillation (AF) < 48 hours in duration.
This single-center, observational study comprised 366 consecutive, unselected patients with short-term AF < 48 hours in duration. During the first 2 years, CV was performed using the conventional approach without TEE. Thereafter, CV guided by TEE was performed in consecutive patients.
TEE revealed left atrial thrombi in 1.4% and left atrial dense spontaneous echo contrast in 10% of patients with short-term AF (n = 207), of whom 63% were receiving anticoagulation therapy. Patients without prior anticoagulation had a 4% prevalence of left atrial thrombi. A low ejection fraction and an enlarged left atrium tended to be associated with an increased prevalence of thrombus or dense spontaneous echo contrast. During the first month after CV, there were no significant differences in the rate of embolic events between the two treatment groups.
These results underline the need for further studies on the usefulness of TEE-guided CV in patients with short-term AF who are not therapeutically anticoagulated at presentation.
本研究旨在探讨经食管超声心动图（TEE）引导的转复（CV）在预防持续时间<48 小时的短期心房颤动（AF）患者发生血栓栓塞并发症中的价值。
这是一项单中心、观察性研究，纳入了 366 例连续、未经选择的持续时间<48 小时的短期 AF 患者。在前 2 年中，采用常规方法进行 CV，不使用 TEE。此后，对连续患者进行 TEE 引导的 CV。
TEE 显示，在 207 例持续时间<48 小时的短期 AF 患者中，有 1.4%的患者存在左心房血栓，10%的患者存在左心房密集自发性回声对比（n = 207），其中 63%正在接受抗凝治疗。未接受抗凝治疗的患者左心房血栓的患病率为 4%。低射血分数和左心房增大往往与血栓或密集自发性回声对比的患病率增加相关。在 CV 后的第一个月，两组患者的栓塞事件发生率无显著差异。
这些结果强调了需要进一步研究 TEE 引导的 CV 在未进行治疗性抗凝的 presenting 期短时间 AF 患者中的有效性。
