The role of echocardiography in the management of atrial fibrillation

Wheeler, Richard; Masani, Navroz

doi:10.1093/ejechocard/jer124

Cited by 17 publications

(8 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…multi-lobed structure of LAA, pectinate muscles within the LAA wall and a reverberation artifact originating from the ridge at the mouth of the left upper pulmonary vein ( Coumadin ridge ). 7 Sometimes, it becomes impossible to differentiate dense SEC from underlying thrombus and in the present case, profuse, dense SEC with its whirling motion created difficulties in diagnosing the thrombus in the LA cavity, presumably due to near identical radio-density. Inter-observer variability in interpretation is another possibility; however, the echocardiography of the present case was scrutinized by two efficient echocardiographers, so, chance of inter-observer variability was less.…”

Section: Discussionmentioning

confidence: 69%

Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis

Am¹,

Salam²,

Sayeed³

et al. 2015

Pak J Med Sci

View full text Add to dashboard Cite

Spontaneous echo contrast (SEC) and thrombus in enlarged left atrium (LA) are common in mitral valvular disease (MVD) and SEC is considered to be a prethrombotic condition. Reliable exclusion of LA thrombus is important before any definitive curative attempts like percutaneous transluminal mitral commissurotomy (PTMC), closed mitral commissurotomy (CMC) or innovative therapies like pulmonary vein isolation and percutaneous closure of the LA appendage. Echocardiography, particularly the transesophageal echocardiography (TEE) is considered to be the gold standard for the diagnosis and to exclude LA thrombus. However, LA thrombus may remain rarely undetected even by TEE potentially making the interventions a risky job. We present a case of mitral stenosis (MS) with giant LA where profuse, dense SEC masked the underlying thrombus in the LA cavity.

show abstract

Section: Discussionmentioning

confidence: 69%

Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis

Am¹,

Salam²,

Sayeed³

et al. 2015

Pak J Med Sci

View full text Add to dashboard Cite

show abstract

“…Transthoracic echocardiography provides an essential evaluation of left atrial and left ventricular size and function while potentially revealing any underlying heart disease that may be a risk factor for AF, such as rheumatic heart disease, mitral valve disease, or ischemia. 22 Left atrial size is a common predictor for the effectiveness of an ablation; a 5 mm increase in anterior-posterior (AP) dimension for the same patient between exams is associated with a 39% greater risk for developing AF for that patient, even status post ablation (Tables 1, 2). 18 However, AP measurements can easily underestimate an oblong left atrium, and LA volume is currently the recommended standard for a more accurate measurement.…”

Section: Role Of Transthoracic Echocardiographymentioning

confidence: 99%

The Role of Echocardiography in Determining the Method of Ablation for the Treatment of Paroxysmal Atrial Fibrillation: A Literature Review

Cone

2018

Journal of Diagnostic Medical Sonography

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, with a prevalence of approximately 0.5% in the general population. 1 The incidence of AF is projected to double from 2010 to 2030, by an estimated 2.6 million cases, increasing total prevalence to 12.1 million cases in the United States. 2 This conduction abnormality is associated with thromboembolic events and decreased cardiac function and can potentially reduce the quality of life in some patients with symptomatic atrial fibrillation. 3 As the understanding behind the pathophysiology of AF develops and new techniques for treatment are introduced, echocardiography has become an increasingly useful tool for both determining which therapy is most appropriate and ruling out a cardiac thrombus prior to cardioversion or an ablation procedure. Two specific treatments are currently available, radiofrequency and cryoballoon ablation, both of which create transmural lesions to disrupt the arrhythmogenic foci causing AF. 4 Depending on clinical presentation and echocardiographic assessment, one technique may be preferred over the other; therefore, it is crucial for sonographers to become familiar with each method and better understand the role of sonography in evaluating for an ablation procedure.

show abstract

“…Despite the utility of TOE for thrombus detection in the LAA [13], a small number of thromboembolic events continue to occur even when no thrombus is detected in a pre-cardioversion [8] or LAA-occlusion setting (1-2%) [5,6]. Possible causes include absent or sub-therapeutic anticoagulation [14] and air embolism due to insufficient venting during LAA occlusion [5].…”

Section: Toe-guided Thrombus Detectionmentioning

confidence: 99%

Left Atrial Appendage Morphology in Patients with Non-Valvular Atrial Fibrillation

Joy¹,

Bertog²,

Betts³

et al. 2017

jshd

View full text Add to dashboard Cite

Aims: Percutaneous left atrial appendage (LAA) occlusion has now become a suitable alternative to oral anticoagulation for stroke prevention in selected patients with atrial fibrillation (AF). However, LAA closure can be technically challenging and results suboptimal, in part due to variable left atrial anatomy.We aimed to characterize LAA morphology and identify potential anatomical pitfalls during LAA closure or LAA thrombus detection during transoesophageal echocardiography (TOE). Methods and Results: 103 patients with AF underwent cardiac magnetic resonance angiography to assess pulmonary venous anatomy. Adequate imaging quality was present in 76 in whom LAA morphology was assessed. The majority of LAAs (71%) were anterolaterally directed and 82% were 'claw'-shaped. However, there was significant variation in anatomy and course in the remainder: 11% were anteverted, 9% laterally directed and 9% retroverted. The shape was cone-like in 8%, fan-like in 5% and s-configured in 5% and there was significant variation in the curvature of the LAA body. While 66% had a single lobe, 30% were bilobed and 4% trilobed; 90% also had additional lobules. Conclusion: Our results demonstrate the significant variability of LAA geometry in AF patients. This may have implications for future device design for percutaneous LAA occlusion. The variable anatomy may affect LAA thrombus detection with TOE emphasizing the importance of multiple views to ensure complete assessment.

show abstract

The role of echocardiography in the management of atrial fibrillation

Cited by 17 publications

References 37 publications

Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis

Spontaneous echo contrast masking thrombus in giant left atrium of mitral stenosis-a dilemma in clinical diagnosis

The Role of Echocardiography in Determining the Method of Ablation for the Treatment of Paroxysmal Atrial Fibrillation: A Literature Review

Left Atrial Appendage Morphology in Patients with Non-Valvular Atrial Fibrillation

Contact Info

Product

Resources

About