How Useful Is Transoesophageal Echocardiography During Electrical Cardioversion for Predicting Long-Term Sinus Rhythm Maintenance?

  • B. De Piccoli
Conference paper


Both pharmacological and electrical cardioversion are widely used in the management of subjects affected by atrial fibrillation (AF). The tachyarrhythmia recurrence rate after restoration of sinus rhythm (SR) is near 40% [1], and about 57% of cases occur during the first 30 days [2]. This cardiac arrhythmia has a deep impact on patient’s haemodynamics and risk of embolic events, so tailored antiarrhythmic and anticoagulant therapy is commonly employed [3] even though it is not free of complications. Many authors have tried to identify predictors of AF reversibility and SR maintenance. Formerly clinical features of the patients affected were focused on [4]. Later, after the introduction of transthoracic echocardiography (TTE), a correlation was established between left atrial (LA) size and AF recurrence [5]. TEE has allowed investigation of the anatomical and functional aspects of the left atrial appendage (LAA) during AF, and it was documented that auricular Doppler flow patterns constitute a predictor of embolic events [6], successful cardioversion [7] and maintenance of SR [8].


Atrial Fibrillation Left Atrial Peak Velocity Atrial Fibrillation Recurrence Left Atrial Appendage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    The National Heart, Lung and Blood Institute Working Group on Atrial Fibrillation(1993) Atrial fibrillation: current understandings and research imperatives. JAm Coll Cardiol 22:1830–1834CrossRefGoogle Scholar
  2. 2.
    Tieleman RG, Van Gelder IC, Crijns HJG et al (1998) Early recurrence of atrial fibrillation afterelectrical cardioversion: a result of fibrillation-induced electricalremodelling of the atria? J Am Coll Cardiol 31:167–173PubMedCrossRefGoogle Scholar
  3. 3.
    CairnsJA,ConnollySJ (1991) Nonrheumatic atrial fibrillation. Risk of stroke and role ofantithrombotic therapy. Circulation 84:469–481PubMedCrossRefGoogle Scholar
  4. 4.
    HallJI, Wood DR (1968) Factors affecting cardioversion of atrial arrhythmias withspecial reference to quinidine. Br Heart J 30:84–90PubMedCrossRefGoogle Scholar
  5. 5.
    HoglundC, Rosenhamer G (1985) Echocardiographic left atrial dimension as a predictorof maintaining sinus rhythm after conversion of atrial fibrillation. Acta MedScand 217:411–415Google Scholar
  6. 6.
    MuggeA, KuhnH,Nikuta P etal(1994) Assessment of left atrial appendage function by biplane transesophagealechocardiography in patients with nonrheumatic atrial fibrillation:identification of a subgroup of patients at increased thromboembolic risk. J AmColl Cardiol 23:599–607CrossRefGoogle Scholar
  7. 7.
    MituschR, GarbeM, SchmuckerG et al (1995)Relation of left atrial appendage function to the duration and reversibility ofnonvalvular atrial fibrillation. Am J Cardiol 75:944–947PubMedCrossRefGoogle Scholar
  8. 8.
    VerhorstPMJ,kamp O, Welling RC et al (1997) Transesophageal echocardiographicpredictors for maintenance of sinus rhythm after electrical cardioversion ofatrial fibrillation. Am J Cardiol 79:1355–1359PubMedCrossRefGoogle Scholar
  9. 9.
    ManningWJ, Leeman DE,GotchPJ, Come PC (1989) Pulsed Doppler evaluation of atrial mechanicalfunction after electrical cardioversion of atrial fibrillation. J Am CollCardiol 13:617–623CrossRefGoogle Scholar
  10. 10.
    Dethy M, Chassat C, Roy D, Mercier LA (1988) Doppler echocardiographic predictors of recurrence ofatrial fibrillation after cardioversion. Am J Cardiol 62:723–726PubMedCrossRefGoogle Scholar
  11. 11.
    GrimmRA,StewartWJ, Maloney JD etal(1993) Impact of electrical cardioversion of atrial fibrillation on left atrialappendage function and smoke: characterization by simultaneous transesophagealechocardiography. J Am Coll Cardiol 22:1359–1366PubMedCrossRefGoogle Scholar
  12. 12.
    FatkinD, Kuchar DL, Thornburn CW, Feneley MP (1994) Transesophageal echocardiographybefore and during direct current cardioversion of atrial fibrillation: evidencefor “atrial stunning” as a mechanism of thromboembolic complications.J Am Coll Cardiol 23:307–316PubMedCrossRefGoogle Scholar
  13. 13.
    RigoF, Raviele A, DePiccoliB etal(1997) Internal atrial defibrillation: what are the effects on mechanicalfunction? In: Raviele A (ed) Cardiac arrhythmias 1997. Proceedings of the 5thInternational Workshop on Cardiac Arrhythmias. Springer, Berlin Heidelberg NewYork, pp 89–99Google Scholar
  14. 14.
    TurittoG, Bandarizadeh B, Salciccioli L et al (1998) Risk stratification forrecurrent tachyarrhythmias in patients with paroxysmal atrial fibrillation andflutter: role of signal averaged electrocardiogram and echocardiography. PacingClin Electrophysiol 21:197–201CrossRefGoogle Scholar
  15. 15.
    MattioliAV, Vivoli D, Bastia E (1997) Doppler echocardiographic parameterspredictive of recurrence of atrial fibrillation of different etiologic origins.J Ultrasound Med 16:695–698PubMedGoogle Scholar
  16. 16.
    BarbierP,Alimento M, Salomon S et al (1998) Determinants of pulmonary venous systolicflow. Circulation 98 (suppl I):I–641 (abstr)Google Scholar
  17. 17.
    Garcia-FernandezMA, Torrecilla EG, San Roman D et al (1992) Left atrial appendage Doppler flow patterns:implications on thrombus formation. Am Heart J 124:955–961PubMedCrossRefGoogle Scholar
  18. 18.
    Laupacis A, Albers G, Dunn M et al (1992) Antithrombotic therapy inatrial fibrillation. Chest 102 (suppl):426S–433SPubMedCrossRefGoogle Scholar
  19. 19.
    Grimm RA,StewartWJ, Black IW etal(1994) Should all patients undergo transesophageal echocardiography beforeelectrical cardioversion of atrial fibrillation? J Am Coll Cardiol 23:533–541PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • B. De Piccoli
    • 1
  1. 1.Unità Operativa di CardiologiaOspedale Umberto IMestre,VeniceItaly

Personalised recommendations