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Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias
BACKGROUND: Although many thromboembolism risk factors are well defined, formation of thrombus or dense spontaneous contrast (sludge) in the left atrium remains enigmatic and confounding. Exclusion of the thrombus is extremely important with respect to planned reversal of sinus rhythm. Data regardin...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Via Medica
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105049/ https://www.ncbi.nlm.nih.gov/pubmed/31225630 http://dx.doi.org/10.5603/CJ.a2019.0056 |
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author | Kosmalska, Katarzyna Rzyman, Małgorzata Miękus, Paweł Gilis-Malinowska, Natasza Nowak, Radosław Fijałkowski, Marcin |
author_facet | Kosmalska, Katarzyna Rzyman, Małgorzata Miękus, Paweł Gilis-Malinowska, Natasza Nowak, Radosław Fijałkowski, Marcin |
author_sort | Kosmalska, Katarzyna |
collection | PubMed |
description | BACKGROUND: Although many thromboembolism risk factors are well defined, formation of thrombus or dense spontaneous contrast (sludge) in the left atrium remains enigmatic and confounding. Exclusion of the thrombus is extremely important with respect to planned reversal of sinus rhythm. Data regarding the routine transesophagal echocardiography (TEE) before cardioversion are inconclusive. The authors focused on analyzing the usefulness of TEE before cardioversion by assessment of factors influencing the risk of thrombus and/or dense spontaneous echo contrast with the intention of extending indications for TEE in the group with a high risk of thrombus or to forgo TEE in the low risk group. METHODS: Two hundred sixty-nine consecutive patients with persistent (> 48 h) atrial fibrillation or atrial flutter, in whom a direct current cardioversion was planned, were undergoing TEE for the detection of the left atrial thrombus or dense spontaneous echo contrast. Additional clinical and echocardiographic data were collected. The relationship between both thrombus and dense spontaneous echo contrast and covariates was analyzed with the use of binary logistic regression. RESULTS: Left atrium (LA) appendage (LAA) thrombus and/or sludge were detected in 79 (29%) patients. Signs of dementia in mini-mental state examination (hazard ratio [HR]: 1.16; p = 0.005), low velocities in LAA (HR: 3.38; p = 0.032); presence of spontaneous echo contrast in LA (HR: 3.38; p = 0,003) consecutive episode of AF (HR: 2.27; p = 0,046); longer duration of atrial fibrillation (HR: 1.009; p = 0.022); were significant predictors of thrombus and/or dense spontaneous echo contrast. None of the patients with a CHA(2)DS(2)VASc score ≤ 1 had thrombus or sludge in the LAA. Among patients with a CHA(2)DS(2)VASc score > 1, the prevalence of thrombus or sludge in LAA was independent of the CHA(2)DS(2)VASc score value. CONCLUSIONS: Amongst many factors, including an established as risk for thromboembolism only a few of them increased the risk for the presence of thrombus in LAA: low velocities in LAA, presence of spontaneous echo contrast, longer duration of arrhythmia, consecutive (not first) arrhythmia episode and signs of dementia from a mini-mental state examination questionnaire. It was believed that there could be a need for an extension of indications of TEE in vast majority of the patients with atrial arrhythmias, due most often to an unpredictable occurrence of thrombus and potentially disastrous thromboembolism. The only exception could have been the group of the patients with a CHA(2)DS(2)VASc score ≤ 1. |
format | Online Article Text |
id | pubmed-8105049 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Via Medica |
record_format | MEDLINE/PubMed |
spelling | pubmed-81050492021-05-10 Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias Kosmalska, Katarzyna Rzyman, Małgorzata Miękus, Paweł Gilis-Malinowska, Natasza Nowak, Radosław Fijałkowski, Marcin Cardiol J Original Article BACKGROUND: Although many thromboembolism risk factors are well defined, formation of thrombus or dense spontaneous contrast (sludge) in the left atrium remains enigmatic and confounding. Exclusion of the thrombus is extremely important with respect to planned reversal of sinus rhythm. Data regarding the routine transesophagal echocardiography (TEE) before cardioversion are inconclusive. The authors focused on analyzing the usefulness of TEE before cardioversion by assessment of factors influencing the risk of thrombus and/or dense spontaneous echo contrast with the intention of extending indications for TEE in the group with a high risk of thrombus or to forgo TEE in the low risk group. METHODS: Two hundred sixty-nine consecutive patients with persistent (> 48 h) atrial fibrillation or atrial flutter, in whom a direct current cardioversion was planned, were undergoing TEE for the detection of the left atrial thrombus or dense spontaneous echo contrast. Additional clinical and echocardiographic data were collected. The relationship between both thrombus and dense spontaneous echo contrast and covariates was analyzed with the use of binary logistic regression. RESULTS: Left atrium (LA) appendage (LAA) thrombus and/or sludge were detected in 79 (29%) patients. Signs of dementia in mini-mental state examination (hazard ratio [HR]: 1.16; p = 0.005), low velocities in LAA (HR: 3.38; p = 0.032); presence of spontaneous echo contrast in LA (HR: 3.38; p = 0,003) consecutive episode of AF (HR: 2.27; p = 0,046); longer duration of atrial fibrillation (HR: 1.009; p = 0.022); were significant predictors of thrombus and/or dense spontaneous echo contrast. None of the patients with a CHA(2)DS(2)VASc score ≤ 1 had thrombus or sludge in the LAA. Among patients with a CHA(2)DS(2)VASc score > 1, the prevalence of thrombus or sludge in LAA was independent of the CHA(2)DS(2)VASc score value. CONCLUSIONS: Amongst many factors, including an established as risk for thromboembolism only a few of them increased the risk for the presence of thrombus in LAA: low velocities in LAA, presence of spontaneous echo contrast, longer duration of arrhythmia, consecutive (not first) arrhythmia episode and signs of dementia from a mini-mental state examination questionnaire. It was believed that there could be a need for an extension of indications of TEE in vast majority of the patients with atrial arrhythmias, due most often to an unpredictable occurrence of thrombus and potentially disastrous thromboembolism. The only exception could have been the group of the patients with a CHA(2)DS(2)VASc score ≤ 1. Via Medica 2021-02-25 /pmc/articles/PMC8105049/ /pubmed/31225630 http://dx.doi.org/10.5603/CJ.a2019.0056 Text en Copyright © 2021 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. |
spellingShingle | Original Article Kosmalska, Katarzyna Rzyman, Małgorzata Miękus, Paweł Gilis-Malinowska, Natasza Nowak, Radosław Fijałkowski, Marcin Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias |
title | Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias |
title_full | Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias |
title_fullStr | Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias |
title_full_unstemmed | Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias |
title_short | Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias |
title_sort | usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105049/ https://www.ncbi.nlm.nih.gov/pubmed/31225630 http://dx.doi.org/10.5603/CJ.a2019.0056 |
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