Atrial fibrillation and cardioversion: role of transesophageal echocardiography

The most common cardiac arrhythmia is atrial fibrillation (AF). Echocardiography has been an important tool in the evaluation of patients with AF. Transesophageal echocardiography (TEE) offers excellent visualization of the atria and accurate identification or exclusion of atrial thrombi. Patients undergoing cardioversion are treated conventionally with therapeutic anticoagulation for 3 weeks before and 4 weeks after cardioversion to decrease the risk of thromboembolism. A TEE-guided strategy has been proposed as an alternative that may lower stroke and bleeding events. Patients without atrial thrombus by TEE are cardioverted on achievement of therapeutic anticoagulation, whereas cardioversion is delayed in patients with any thrombus. The two management strategies comparably lower the patient's embolic risk when the guidelines are properly followed. The TEE-guided approach offers the advantage of simplified anticoagulation management and may lower the incidence of bleeding complications.