TEE-guided Cardioversion is Feasible and Safe in Patients with Nonvalvular Atrial Fibrillation

Elective cardioversion (CV) of atrial fibrillation is associated with an increased risak for systemic thromboembolic events. The purpose of this study was to determine the feasibility and safety of transesophageal echocardiography (TEE) guided CV with short-term anticoagulation in patients with nonvalvular atrial fibrillation (NV AF). Two-hundred-fifty-two consecutive patients ( ı ı 7 men, ı 35 women, mean age 62.6 ± 10) w ith NV AF were included in the study. The inclusion eriterian was a elinical d uration of atrial fibrillation more than 2 days and less than ı year duration. Seventy-three patients underwent conventional transthorasic echocardiography (TTE) followed by 3 weeks of anticoagulation. Subsegmently 58 of them were converted to sinus rhythm (27 pharmacological, ı 8 electrical and 13 spontaneous). One- hundred and seventy-nine patients underwent conventional TTE followed by TEE. Six patients with evidence of atrial thrombi were excluded and received prolonged warfarin treatment. Patients in whon TEE revealed no atrial or ventricular thrombi underwent pharrnacological or electrical CV under IV heparin therapy followed by warfarin for ı month. Onehundred and sixty-seven patients had successful CV to sin us rhythm ( electrical in 7 ı, pharmacological in 71 , spontaneous in 25). All patients w ere followed up for one month after discharge. There were no documented thromboembolic complications during hospitalization or in the follow-up period. It is concluded that in patients w ith NV AF, TEE guided CV without previous long terrn anticoagulation is a feasible and a safe approach.