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• W2069432912 abstract "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 02215Search for more papers by this author and Pamela S. Douglas, MDBeth Israel Deaconess Medical Center; Boston, MA 02215Search for more papers by this authorAuthor, 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. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet. 1993; 342:1255-62. Google Scholar3. Risk factors for thromboembolism during aspirin therapy in patients with atrial fibrillation: the Stroke Prevention in Atrial Fibrillation Study. Stroke Prevention in Atrial Fibrillation Investigators. Journal of Stroke and Cerebrovascular Disorders. 1995; 5:147-57. Google Scholar4. Manning WJ, Weintraub RM, Waksmonski CA, Haering JM, Rooney PS, Maslow AD, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med. 1995; 123:817-22. Google Scholar5. Manning WJ, Silverman DI, Keighley CS, Oettgen P, Douglas PS. Transesophageal echocardiographically facilitated early cardioversion from atrial fibrillation using short-term anticoagulation: final results of a prospective 4.5-year study. J Am Coll Cardiol. 1995; 25:1354-61. Google Scholar6. 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. Leung DY, Davidson PM, Cranney GB, Walsh WF. Thromboembolic risks of left atrial thrombus detected by transesophageal echocardiogram. Am J Cardiol. 1997; 79:626-9. Google Scholar11. Goldman MJ. The management of chronic atrial fibrillation: indications for and method of conversion to sinus rhythm. Prog Cardiovasc Dis. 1960; 465-79. Google Scholar12. Collins LJ, Silverman DI, Douglas PS, Manning WJ. Cardioversion of nonrheumatic atrial fibrillation. Reduced thromboembolic complications with 4 weeks of precardioversion anticoagulation are related to atrial thrombus resolution. Circulation. 1995; 92:160-3. Google Scholar13. Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. The French Study of Aortic Plaques in Stroke Group. N Engl J Med. 1996; 334:1216-21. Google Scholar14. Cox JL, Boineau JP, Schuessler RB, Ferguson TB Jr, Cain ME, Lindsay BD, et al. Successful surgical treatment of atrial fibrillation. Review and clinical update. 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 InformationAffiliations: 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. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe impact of atherosclerotic vascular disease in predicting a stroke, thromboembolism and mortality in atrial fibrillation patients: a systematic reviewInteractions Between Cardiovascular and Cerebrovascular DiseaseTransnasal transesophageal echocardiography in the detection of left atrial thrombusChapter 51 The interactions between cardiovascular and cerebrovascular diseaseRole of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillationAnticoagulation Before and After Percutaneous Balloon Valvuloplasty for Mitral StenosisUse of Oral Anticoagulants in Older PatientsAtrial Fibrillation and Thromboembolism: A Decade of Progress in Stroke PreventionRobert G. Hart, MD and Jonathan L. 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 Issue Published: 15 April 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ..." @default.
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