Transoesophageal echo before cardioversion for AF: Reviewing the evidence

This article examines whether transoesophageal echocardiography (TOE) should be per formed on all patients before electrical cardioversion for atrial fibrillation (AF). The impact of AF within the healthcare setting is high and creates a considerable demand on the financial and clinical resources of the NHS as well as the health implications for patients. Cardioversion of AF to sinus rhythm is an established treatment for some patients, but the risk of emboli and subsequent embolic events needs to be ascertained. TOE is effective in establishing the risk of intracardiac emboli and its usage in the clinical setting is increasing. A review of the available literature supports the use of TOE as a prerequisite to cardioversion in some groups of patients but not all. Where facilities and expertise exist to deliver this service, it can offer better treatment to qualifying patients.