RT-169
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Transesophageal echocardiography in cardioversion patients: is its role fully accepted?
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Stefano De Castro, Maria Penco*, Federica Papetti, Domenico Cartoni, Rachele Adorisio**, Sergio Beni, Francesco Fedele**.
Dept. of Clinical Medicine, *Cardiology University of L’Aquila, **Dept. of Cardiovascular and Respiratory Sciences, “La Sapienza” University of Rome, Italy
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Abstract
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Thromboembolism, as a consequence of atrial fibrillation, is a major
cause of morbidity and mortality and it is due to dislodgement of fresh thrombi at the time of return of atrial
mechanic function, after chemical and electrical cardioversion.
The benefit of anticoagulation in the pericardioversion period has been recognized, and warfarin therapy
recommended in all patients with atrial fibrillation >2 days in duration. However a) use of several weeks of
anticoagulation is associated with higher risk of hemorragic complications, b) delay in reversion to sinus rhythm
decreases chances of mantaining normal sinus rhythm after cardioversion.
Target in patients management is, then, shortening or elimination of anticoagulation therapy before
cardioversion, and transesophageal echocardiography makes it possible. The concept is simple: if embolic
events are due to clots dislodgement from left atrium, when echocardiographic images are negative for atrial
thrombi or spontaneous echo contrast, cardioversion can be attempted and anticoagulation shortened.
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Key Words
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