Journal of the American Society of Echocardiography
Volume 22, Issue 12 , Pages 1403-1408 , December 2009

Prevalence of Left Atrial Thrombus and Dense Spontaneous Echo Contrast in Patients With Short-Term Atrial Fibrillation < 48 Hours Undergoing Cardioversion: Value of Transesophageal Echocardiography to Guide Cardioversion

  • Thomas Kleemann, MD

      Affiliations

    • Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Ludwigshafen, Germany
    • Corresponding Author InformationReprint requests: Thomas Kleemann, MD, Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Bremserstraße 79, D-67063 Ludwigshafen, Germany.
    • ,
  • Torsten Becker, MD

      Affiliations

    • Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Ludwigshafen, Germany
    • ,
  • Margit Strauss, MD

      Affiliations

    • Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Ludwigshafen, Germany
    • ,
  • Steffen Schneider, PhD

      Affiliations

    • Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • ,
  • Karlheinz Seidl, MD, FESC

      Affiliations

    • Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Ludwigshafen, Germany

References 

  1. Bernhardt P, Schmidt H, Sommer T, Luderitz B, Omran H. Atrial fibrillation—patients at high risk for cerebral embolism. Clin Res Cardiol. 2006;95:148–153
  2. Bernhardt P, Schmidt H, Hammerstingl C, Luderitz B, Omran H. Patients with atrial fibrillation and dense spontaneous echo contrast at high risk: a prospective and serial follow-up over 12 months with transesophageal echocardiography and cerebral magnetic resonance imaging. J Am Coll Cardiol. 2005;45:1807–1812
  3. Bernhardt P, Schmidt H, Hammerstingl C, Luderitz B, Omran H. Atrial thrombi—a prospective follow-up study over 3 years with transesophageal echocardiography and cranial magnetic resonance imaging. Echocardiography. 2006;23:388–394
  4. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006;8:651–745
  5. Pearson AC, Labovitz AJ, Tatineni S, Gomez CR. Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol. 1991;17:66–72
  6. Acar J, Cormier B, Grimberg D, Kawthekar G, Iung B, Scheuer B, et al. Diagnosis of left atrial thrombi in mitral stenosis—usefulness of ultrasound techniques compared with other methods. Eur Heart J. 1991;12(suppl):70–76
  7. Lin SL, Hsu TL, Liou JY, Chen CH, Chang MS, Chiang HT, et al. Usefulness of transesophageal echocardiography for the detection of left atrial thrombi in patients with rheumatic heart disease. Echocardiography. 1992;9:161–168
  8. Castello R, Pearson AC, Labovitz AJ. Prevalence and clinical implications of atrial spontaneous contrast in patients undergoing transesophageal echocardiography. J Cardiol. 1990;65:1149–1153
  9. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Transoesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. Ann Intern Med. 1998;128:639–647
  10. Seidl K, Rameken M, Drögemüller A, Vater M, Brandt A, Schwacke H, et al. Embolic events in patients with atrial fibrillation and effective anticoagulation: value of transesophageal echocardiography to guide direct-current cardioversion. Final results of the Ludwigshafen Observational Cardioversion Study. J Am Coll Cardiol. 2002;39:1436–1442
  11. Klein AL, Grimm RA, Murray RD, Apperson-Hansen C, Asinger RW, Black IW, et al. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med. 2001;344:1411–1420
  12. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23:961–969
  13. Miyazaki S, Ito T, Suwa M, Nakamura T, Kobashi A, Kitaura Y. Role of transesophageal echocardiography in the prediction of thromboembolism in patients with chronic nonvalvular atrial fibrillation. Jpn Circ J. 2001;65:874–878
  14. Thambidorai SK, Murray RD, Parakh K, Shah TK, Black IW, Jasper SE, et al. Utility of transesophageal echocardiography in identification of thrombogenic milieu in patients with atrial fibrillation (an ACUTE ancillary study). Am J Cardiol. 2005;96:935–941
  15. Kleemann T, Becker T, Doenges K, Vater M, Gut B, Schneider S, et al. The prognostic impact of successful cardioversion of atrial fibrillation in patients with organic heart disease. Clin Res Cardiol. 2007;96:103–108
  16. Becker T, Kleemann T, Strauss M, Doenges K, Schneider S, Senges J, et al. Long-term prognosis after cardioversion of the first episode of symptomatic atrial fibrillation: a condition believed to be benign revised. Clin Res Cardiol. 2008;97:74–82
  17. Vincelj J, Sokol I, Jaksic O. Prevalence and clinical significance of left atrial spontaneous echo contrast detected by transesophageal echocardiography. Echocardiography. 2002;19:319–324
  18. Stoddard MF, Dawkins PR, Prince CR, Ammash NM. Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study. J Am Coll Cardiol. 1995;25:452–459
  19. Atrial Fibrillation Investigators. Echocardiographic predictors of stroke in patients with atrial fibrillation: a prospective study of 1066 patients from 3 clinical trials. Arch Intern Med. 1998;158:1316–1320
  20. Stroke Prevention in Atrial Fibrillation Investigators. Risk factors for thromboembolism during aspirin therapy in patients with atrial fibrillation: the Stroke Prevention in Atrial Fibrillation study. J Stroke Cerebrovasc Dis. 1995;5:147–157
  21. Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation, II: echocardiographic features of patients at risk. Ann Intern Med. 1992;116:6–12
  22. Rader VJ, Khumri TM, Idupulapati M, Stoner CN, Magalski A, Main ML. Clinical predictors of left atrial thrombus and spontaneous echocardiographic contrast in patients with atrial fibrillation. J Am Soc Echocardiogr. 2007;20:1181–1185
  23. Page RL, Tilsch TW, Connolly SJ, Schnell DJ, Marcello SR, Wilkinson WE, et al. Asymptomatic or “silent” atrial fibrillation: frequency in untreated patients and patients receiving azimilide. Circulation. 2003;107:1141–1145
  24. Savelieva I, Camm AJ. Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J Interv Card Electrophysiol. 2000;4:369–382
  25. Hart RG, Pearce LA, Miller VT, Anderson DC, Rothrock JF, Albers GW, et al. Cardioembolic vs noncardioembolic strokes in atrial fibrillation: frequency and effect of antithrombotic agents in the stroke prevention in atrial fibrillation studies. Cerebrovasc Dis. 2000;10:39–43
  26. Berger M, Schweitzer P. Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol. 1998;82:1545–1547
  27. Sheikhzadeh A, Ehlermann P. Atheromatous disease of the thoracic aorta and systemic embolism. Clinical picture and therapeutic challenge. Z Kardiol. 2004;93:10–17
  28. Petty GW, Khanderia BK, Meissner I, Whisnant JP, Rocca WA, Sicks JD, et al. Population-based study of the relationship between atherosclerotic aortic debris and cerebrovascular ischemic events. Mayo Clin Proc. 2006;81:609–614

PII: S0894-7317(09)00858-X

doi: 10.1016/j.echo.2009.09.015

Journal of the American Society of Echocardiography
Volume 22, Issue 12 , Pages 1403-1408 , December 2009

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