Abstract

Despite the indisputable role of anticoagulation therapy for atrial fibrillation (AF) patients at risk for stroke, anticoagulants remain under-used in everyday clinical practice. We assumed that by performing trans-oesophageal echocardiography (TEE) on patients with AF who were not on anticoagulation treatment prior to the procedure, and by explaining to them the TEE images obtained, as well as the possible consequences of these findings, we could convince patients to start anticoagulation therapy. The main objective of the study was to assess the examined patients' adherence to warfarin therapy over a two-year period. We conducted a prospective TEE study from February 2006 to December 2008 on 70 patients with chronic AF who were not on anticoagulation treatment. Mean patient age was 65.85 ± 10.02 years and 68.57% were women. Thrombus in the left atrial appendage was found in 25 (35.71%) patients. Fifty-four (77.14%) patients had thrombi or spontaneous echo contrast in at least one of their supraventricular cavities. Following the procedure and with detailed explanation to the patients of their TEE findings, we managed to start anticoagulation therapy on 60 (85.71%) patients. At the end of the follow-up period of 23.76 ± 2.8 months, 53 (75.71%) patients remained on warfarin therapy. The rest of the surviving patients settled for thrombo-prophylaxis with aspirin. TEE is a valuable method that, in addition to its diagnostic possibilities, could also serve as a convincing visual method of putting atrial fibrillation patients onto an anticoagulation regimen.

Highlights

  • Despite the indisputable role of anticoagulation therapy for atrial fibrillation (AF) patients at risk for stroke, anticoagulants remain under-used in everyday clinical practice

  • The aim of this study was to perform trans-oesophageal echocardiography (TEE) in patients with chronic non-valvular atrial fibrillation who did not take anticoagulation therapy prior to the procedure, in order to asses the prevalence of atrial thrombi and spontaneous echo contrast (SEC) in these patients

  • Atrial fibrillation was diagnosed by at least two electrocardiograms (ECG), presenting with the absence of P waves before each QRS complex, and replaced instead by fibrillatory ‘f’ waves varying in size, shape and timing

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Summary

Introduction

Despite the indisputable role of anticoagulation therapy for atrial fibrillation (AF) patients at risk for stroke, anticoagulants remain under-used in everyday clinical practice. We assumed that by performing trans-oesophageal echocardiography (TEE) on patients with AF who were not on anticoagulation treatment prior to the procedure, and by explaining to them the TEE images obtained, as well as the possible consequences of these findings, we could convince patients to start anticoagulation therapy. The main objective of the study was to assess the examined patients’ adherence to warfarin therapy over a two-year period. Methods and results: We conducted a prospective TEE study from February 2006 to December 2008 on 70 patients with chronic AF who were not on anticoagulation treatment. Mean patient age was 65.85 ± 10.02 years and 68.57% were women. Thrombus in the left atrial appendage was found in 25 (35.71%) patients. Fifty-four (77.14%) patients had thrombi or spontaneous echo contrast in at least one of their supraventricular cavities

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