A TEE-guided approach to early cardioversion in atrial fibrillation appears to have a safety profile similar to conventional therapy, offering simplified anticoagulation management.
Does a TEE-guided approach to early cardioversion improve safety and cost-effectiveness compared to conventional therapy in patients with atrial fibrillation?
A TEE-guided approach to early cardioversion in AF patients is safe, cost-effective (if TTE is omitted), and allows for more rapid recovery of atrial mechanical function compared to conventional therapy.
Echocardiography has emerged as a fundamental tool in the evaluation of patients with atrial fibrillation (AF). Transthoracic echocardiography remains a primary tool for the evaluation and management of many patients presenting with their first episode of AF, but it is not adequate for exclusion of atrial thrombi. TEE offers excellent visualization of the atria and accurate identification or exclusion of thrombi. In concert with therapeutic anticoagulation, a TEE-guided approach to early cardioversion appears to have a safety profile similar to that of conventional therapy (1 month of precardioversion warfarin). The TEE-guided approach offers the advantages of simplified anticoagulation management and shorter duration of sustained AF, thereby allowing for a more rapid recovery of atrial mechanical function. Warfarin should be continued for 1 month after cardioversion to allow for more complete recovery of atrial function and for prophylaxis should the patient revert to AF. Cost-effectiveness models demonstrate that TEE-guided cardioversion represents a cost-effective strategy, but only if the transthoracic echocardiogram is omitted. For patients with a thrombus on the initial TEE, follow-up TEE (to document thrombus resolution) is recommended before cardioversion.
Silverman et al. (Tue,) conducted a review in Atrial Fibrillation. Transesophageal echocardiography (TEE)-guided approach to early cardioversion vs. Conventional therapy (1 month of precardioversion warfarin) was evaluated. A TEE-guided approach to early cardioversion in atrial fibrillation appears to have a safety profile similar to conventional therapy, offering simplified anticoagulation management.