Transesophageal Echocardiography and Atrial Fibrillation: Added Value or Expensive Toy?
Authors: Warren J. Manning
Journal: Annals of Internal Medicine (1998)

Editorials15 April 1998Transesophageal Echocardiography and Atrial Fibrillation: Added Value or Expensive Toy?Warren J. Manning, MD and Pamela S. Douglas, MDWarren J. Manning, MDBeth Israel Deaconess Medical Center; Boston, MA 02215 and Pamela S. Douglas, MDBeth Israel Deaconess Medical Center; Boston, MA 02215Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-8-199804150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Atrial fibrillation, the most common type of sustained arrhythmia, is associated with considerable morbidity and mortality from stroke and systemic thromboembolism. Several large, randomized, multicenter studies have documented that systemic warfarin anticoagulation reduces thromboembolic complications associated with atrial fibrillation by two thirds [1, 2], presumably because of warfarin's efficacy in inhibiting thrombus formation within the stagnant left atrial appendage. Long-term warfarin therapy, however, is associated with the cost and inconvenience of monitoring and high morbidity and mortality. These effects are especially prevalent among elderly persons, a population at high risk for thromboembolic complications of atrial fibrillation [3]. The identification of ...References1. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized, controlled trials. Atrial Fibrillation Investigators. Arch Intern Med. 1994; 154:1449-57. Google Scholar2. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. 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Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Ann Intern Med. 1998; 128:639-47. Google Scholar7. Stollberger C, Chnupa P, Kronik G, Brainin M, Finsterer J, Schneider B, et al. Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. Ann Intern Med. 1998; 128:630-8. Google Scholar8. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet. 1996; 348:633-8. Google Scholar9. Manning WJ, Silverman DI, Keighley KS, Waksmonski CA, Oettgen P, Douglas PS. Prevalence of residual left atrial thrombi among patients with acute thromboembolism and newly recognized atrial fibrillation. Arch Intern Med. 1995; 155:2193-7. Google Scholar10. 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JAMA. 1991; 266:1976-80. Google Scholar15. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996; 61:755-9. Google Scholar16. Daniel WG, Nellessen U, Schroder E, Nonnast-Daniel B, Bednarski P, Nikutta P, et al. Left atrial spontaneous echo contrast in mitral valve disease: an indicator for an increased thromboembolic risk. J Am Coll Cardiol. 1988; 11:1204-11. Google Scholar17. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994; 23:961-9. Google Scholar18. Black IW, Hopkins AP, Lee LC, Walsh WF. Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol. 1991; 18:398-404. Google Scholar19. Seto TB, Taira DA, Tsevat J, Manning WJ. Cost-effectiveness of transesophageal echocardiography-guided cardioversion: a decision analytic model for patients admitted to the hospital with atrial fibrillation. J Am Coll Cardiol. 1997; 29:122-30. Google Scholar20. Tsai LM, Chen JH, Lin LJ, Teng JK. Natural history of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation. Am J Cardiol. 1997; 80:897-900. Google Scholar Author, Article, and Disclosure InformationAuthors: Warren J. Manning, MD; Pamela S. Douglas, MDAffiliations: Beth Israel Deaconess Medical Center; Boston, MA 02215Corresponding Author: Pamela S. Douglas, MD, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.Current Author Addresses: Drs. Manning and Douglas: Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. 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Halperin, MDEpidemiology and significance of atrial fibrillationMedical advice editorials: Transferring medical science into clinical practiceAortic Plaque in Atrial FibrillationAntithrombotic Therapy in Nonrheumatic/Nonvalvular Atrial Fibrillation 15 April 1998Volume 128, Issue 8Page: 685-687KeywordsAspirinAtrial fibrillationEchocardiographyMedical risk factorsMorbidityMortalityResearch designStrokeThromboembolismThrombosis ePublished: 15 August 2000 Issue Published: 15 April 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...