Accuracy of Transesophageal Echocardiography for Identifying Left Atrial Thrombi: A Prospective, Intraoperative Study

Wj, Manning; Rm, Weintraub; Ca, Waksmonski; Jm, Haering; Ps, Rooney; Maslow, AD; Rg, Johnson; Douglas, Pamela S.

doi:10.7326/0003-4819-123-11-199512010-00001

Cited by 428 publications

(230 citation statements)

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“…23,26,27 Using precardioversion TEE, Manning 24 assessed early cardioversion in patients with AF for longer than 48 h without atrial thrombi. Patients without thrombus received anticoagulation with heparin prior to and for 24 h after either pharmacological or electrical cardioversion.…”

Section: Treatment Of Spontaneous Echo Contrastmentioning

confidence: 99%

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Patel

Flaker

2007

Clinical Cardiology

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The 2006 American Heart Association guidelines for management of patients with atrial fibrillation state: ''For patients with no identifiable thrombus in the left atrium (LA) or left atrial appendage (LAA), cardioversion (CV) is reasonable immediately after anticoagulation with unfractionated heparin. Thereafter, continuation of oral anticoagulation is reasonable for an anticoagulation period of at least 4 weeks.'' For patients with thrombus identified by transesophageal echocardiography, guidelines recommend therapeutic oral anticoagulation for 3 weeks prior to and 4 weeks after elective cardioversion.Patients with spontaneous echo contrast spontaneous echo contrast (SEC) identified by transesophageal echocardiogram (TEE) have a high risk of thromboembolic events, 1 -8 however, the guidelines do not address whether patients with SEC without thrombus can be safely cardioverted. This paper reviews the literature describing the pathogenesis of SEC, how it is detected, and whether elective cardioversion is safe.On the basis of our review, we believe that the risk of cardioembolic stroke after cardioversion of a patient with SEC is low, regardless of anticoagulation. The safe conclusion is that patients with SEC on TEE should receive therapeutic anticoagulation prior to cardioversion if possible and early cardioversion is not contraindicated.

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Section: Treatment Of Spontaneous Echo Contrastmentioning

confidence: 99%

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Patel

Flaker

2007

Clinical Cardiology

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“…However, TEE is a semi-invasive procedure that requires special skills for proper execution and interpretation. A prospective study reported 100% sensitivity [95% confidence interval (CI): 74-100%], 99% specificity (95% CI: 97-99.9%), and 100% negative predictive value (NPV) (217/217), but only an 86% positive predictive value (PPV) (12/14) for a population with a 5.2% thrombi prevalence [36]. The investigators suggested that this low PPV resulted from trabeculations or pectinate muscles in the LAA being misinterpreted as thrombi by inexperienced observers.…”

Section: Cviamentioning

confidence: 99%

“…1) [35,36]. Therefore, TEE is currently the most widelyused method and is accepted as the reference modality for diagnosing and excluding the presence of LAA thrombi.…”

Section: Cviamentioning

confidence: 99%

Technological Improvements in Cardiac Thrombus Diagnosis

Hur

Hong

et al. 2017

Cardiovasc Imaging Asia

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Cardiovascular imaging technology constantly evolves and provides more testing options for evaluating cardiovascular morphology and function. Accurate detection and diagnosis of cardiac thrombi are important in clinical practice, as they provide a substrate for embolic events and a rationale for anticoagulation therapy. Echocardiography, predominantly transesophageal echocardiography, has been used as a reference modality to assess flow stasis and cardiac thrombus. Cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMRI) have also been proposed and tested as alternative imaging modalities for cardiac thrombus detection. Given the noninvasive nature of CCT and CMR, developing strategies based on these modalities for the detection of cardiac thrombi and flow stasis is of great clinical interest. However, these advanced imaging techniques should add value in the clinical setting.

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“…TOE is considered the gold standard modality in detecting LA or LAA thrombi. In one intraoperative study, TOE was compared with direct visualization of LA contents at surgery and had a sensitivity and specificity of 100% and 99%, respectively [43] 3D TOE can help discriminate pectinate muscles from thrombus in cases with diagnostics doubts [44]. In case of uncertainty about the presence of a thrombus in the LAA, the use of ultrasound contrast can be helpful [45].…”

Section: Thrombusmentioning

confidence: 99%

Role of Imaging in Left Atrial Appendage Occlusion

Lempereur

Aminian

Potter

et al. 2017

ijcp

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Percutaneous left atrial appendage (LAA) occlusion is now a valid alternative to longterm oral anticoagulation in patients with non-valvular atrial fibrillation at high thromboembolism risk, especially for patients who are considered ineligible for anticoagulation. The most frequently used occluders worldwide include the WATCHAMN (Boston Scientific, Natick, MA, USA) and the Amplatzer Cardiac Plug or Amulet (St. Jude Medical/Abbott, St Paul, MN, USA) devices. Multimodality imaging is key in the understanding of 3D aspects of the LAA and surrounding structures anatomy. Imaging is essential for procedural planning, during each step of the procedure and for device surveillance after implantation. Multimodality imaging, including 2D/3D echocardiography, fluoroscopy, and cardiac computed tomography can increase the safety and efficacy of the procedure.

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Accuracy of Transesophageal Echocardiography for Identifying Left Atrial Thrombi: A Prospective, Intraoperative Study

Abstract: Transesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.

Cited by 428 publications

References 0 publications

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Is Early Cardioversion for Atrial Fibrillation Safe in Patients with Spontaneous Echocardiographic Contrast?

Technological Improvements in Cardiac Thrombus Diagnosis

Role of Imaging in Left Atrial Appendage Occlusion

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