The TEE ultrasound provides detailed images of blood clots through an instrument that is placed in the esophagus that bounces sound waves off the heart. Atrial fibrillation affects more than 2 million Americans, increases the risk of stroke or death and is a disease of the elderly. Physicians frequently treat atrial fibrillation with electrical cardioversion, which is applying shocks to patients' chests to restore normal heart rhythm. In addition, the blood clots created by atrial fibrillation can be dislodged from the heart and move to organs such as the spleen or kidneys, or to the arms or legs. Since the 1960s, the conventional way to treat these patients has been to give them anticoagulation, or blood thinners, for three weeks before the anticipated electrical cardioversion.
Patients continue taking anticoagulation for four weeks after treatment.
Bleeding risk ranges from minor problems such as nosebleeds to more serious internal bleeding. In addition, many clinicians do not adhere to the conventional treatment guidelines. The TEE-guided strategy was proposed as a more modern approach that would actually detect blood clots in the heart and allow safe and early electrical cardioversion. The patients had atrial fibrillation lasting at least two days and were candidates for electrical cardioversion. Blood clots were discovered in 14 percent of the patients assigned to the TEE group.