Abstract 9383: Full versus Limited Transesophageal Echocardiography at the Time of Cardioversion for Atrial Fibrillation

Abstract

Introduction: Transesophageal echocardiography (TEE) is frequently used to evaluate the left atrial appendage (LAA) prior to direct-current cardioversion (DCC) for atrial fibrillation (AF). Clinically relevant findings may be discovered prior to DCC. The optimal TEE study protocol at the time of DCC is unknown. Methods: One-hundred and fifty patients undergoing TEE-guided DCC for AF were retrospectively analyzed. Patients were separated into two groups based on the type of study performed. Comprehensive studies were defined as full TEEs (F-TEE). Studies focused on the LAA were defined as limited TEEs (L-TEE). The TEE findings between both groups were compared. Results: Among 150 patients included in the study (mean age, 66.9 ± 14.3 years; 31% female), 81 (54%) had an F-TEE and 69 (46%) had an L-TEE. Abnormal findings were significantly higher in the F-TEE group compared with the L-TEE group (76.5% versus 47.8%; P<0.005). In patients with a prior study, a new finding was observed more often in the F-TEE versus L-TEE group (56.5% versus 22.0%; P<0.005). In patients with a prior study performed within the previous 2 months, a new finding was observed in 55.3% versus 28.1% (P=0.022). F-TEE took longer to perform compared to L-TEE (7.9 ± 3.3 versus 4.3 ± 3.8 minutes; P<0.005). Conclusions: Among patients undergoing TEE-guided DCC for AF, F-TEE reported significantly more cardiovascular pathology when compared to L-TEE. Among patients with prior echocardiographic studies, F-TEE reported significantly more new findings, regardless of whether the prior study was recent or remote. We believe our findings offer a convincing argument to adopt an F-TEE protocol for studies performed pre-DCC.