Preprocedural Multimodality Imaging in Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient’s characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.

Comparison of Transthoracic and Trans-Esophageal Echocardiography in the Detection of Cardiac Emboli in Afib Patients

“…However, the comparative effectiveness of these two modalities in detecting cardiac emboli in AFib patients warranted investigation (6). The effectiveness of TTE and TEE in detecting cardiac emboli in AFib patients remained unclear, necessitating a comparative analysis to determine the optimal imaging modality for clinical practice (7,8). The specific patient characteristics and clinical scenarios where one modality may have offered advantages over the other required clarification (9).…”