Key result
Microbubble contrast agent use during transesophageal echocardiography enhanced left atrial appendage visualization and identified previously unsuspected thrombus compared to noncontrast images.
Why the study?
Does the use of microbubble contrast agent improve interpretation of TEE images and identification of LAA thrombus in patients referred for TEE-guided cardioversion?
Observational (n=100)
Does the use of microbubble contrast agent improve interpretation of TEE images and identification of LAA thrombus in patients referred for TEE-guided cardioversion?
The use of microbubble contrast agents during TEE-guided cardioversion enhances LAA visualization and improves the identification of intracardiac thrombi compared to noncontrast imaging.
Answers are grounded in this paper and cite their sources.
May aid LAA thrombus detection on TEE for cardioversion; leaves open need for RCTs before practice change.
OBJECTIVES: The aim of our study was to demonstrate that the use of contrast microbubbles during transesophageal echocardiography (TEE) guided cardioversion will improve interpretation of the TEE images. BACKGROUND: TEE-guided cardioversion of atrial flutter or fibrillation (AF) is a safe and proven method to restore sinus rhythm. However, artifacts and dense spontaneous echo contrast in the left atrial appendage (LAA) can sometimes decrease the level of confidence in excluding the presence of thrombus. METHODS: One hundred patients referred for TEE-guided cardioversion were prospectively enrolled and microbubble contrast agent (DEFINITY) was administered after the clinical decision had been made regarding suitability for cardioversion. Noncontrast and contrast images were compared during subsequent offline analysis. RESULTS: LAA dimensions and contractility indices were higher, artifacts were significantly differentiated, previously unsuspected LAA filling defects were identified, and the level of confidence in excluding thrombus was enhanced in the contrast images when compared to the noncontrast images. After 4 months follow-up, 1 stroke-associated death occurred in a patient who had LAA thrombus recognized only by contrast. Left atrial appendage visualization is enhanced with microbubble contrast agent use during transesophageal echocardiography guided cardioversion and is useful in identification of intracardiac thrombus.
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Bernier et al. (2013) conducted an observational in Atrial flutter or fibrillation (n=100). Microbubble contrast agent (DEFINITY) vs. Noncontrast images was evaluated on Interpretation of TEE images (LAA dimensions, contractility, artifacts, filling defects, confidence in excluding thrombus). Microbubble contrast agent use during transesophageal echocardiography enhanced left atrial appendage visualization and identified previously unsuspected thrombus compared to noncontrast images.
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