954-5 Pre-cardioversion Transesophageal Echocardiography as a Predictor of Unsuccessful Electrical Cardioversion of Atrial Fibrillation

Abstract

To assess the utility of transesophageal echocardiography (TEE) precardioversion (CV) of atrial fibrillation (AF) as a predictor of unsuccessful CV (no reversion or recurrence < 24 h.), 68 patients with AF and atrial flutter (8) were studied. Mean aged was 61 ± 9 years. TEE was performed before CV Left atrial (LA) and left atrial appendage (LAA) size, spontaneous echo contrast (SCE) grade (from 0 to 3) and mechanical function were evaluated. We measured LAA emptying velocities (+) and total wave velocity (T = emptying + filling waves). LAA flow was classified in 6 patterns (IA, IB, II, IIIA, IIIB, IV): detected in sinus rhythm II), flutter (II). AF (III). and no identifiable flow waves (IV). The patterns IB, IIIB, and IV represented LAA mechanical disfunction, and were defined by an emptying wave less than 20 cm/sec. 14 patients had recurrent AF 24 h. after CV. The remaining patients were in sinus rhythm. There were no differences between both groups with regard to aged, mitral stenosis prevalence, functional class, atrial flutter, LA size and LAA dimension and history of embolization. In contrast, the unsuccessful group had longer duration of AF, higher SEC grade and higher mechanical disfunction. CV N LA LAA SCE SCE (2–3) SCE (+) (T) (IIIB-IV) Unsuccessful 14 1.5 ± 1 71% 1.3 ± 0.9 26 54 74% Successful 51 1.1 ± 1 43% * 0.9 ± 1.1 35 72 43% * * p < 0.05 LA spontaneous echo contrast grade 2–3 and/or LAA IIIB-IV flow pattern had a diagnostic sensibility of 79%, specificity 60%, positive predictive value 35%, and negative 91% for unsuccessful CV. TEE performed pre-CV is useful in detecting patients with higher probability of unsuccessful CV. Higher LA disfunction with spontaneous echo contrast grade 2–3 and/or higher LAA mechanical disfunction (IIIB-IV) with spontaneous echo contrast grade 2–3, was found in this group of patients. All this can be helpful to select patients for CV.