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Review
. 2003 Dec;89(12):1447-54.
doi: 10.1136/heart.89.12.1447.

The role of echocardiography in atrial fibrillation and cardioversion

Richard W Troughton  1 , Craig R Asher, Allan L Klein
Affiliations
Review

The role of echocardiography in atrial fibrillation and cardioversion

Richard W Troughton et al. Heart. 2003 Dec.
No abstract available

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Figures

Figure 1
Figure 1
Images of the left atrium and left atrial appendage (LAA) depicting the spectrum of flow stasis and thromboembolic risk from “smoke” through thrombus. (A) LAA thrombus detected in a patient with atrial fibrillation (AF) undergoing transoesophageal echo (TOE) before cardioversion. Note the well formed rounded upper edge of the thrombus (arrow). (B) “Sludge” in the apex of the LAA detected by TOE in a patient with AF. Note the meniscus at the upper edge of the sludge (arrow). (C) Spontaneous echo contrast or “smoke” swirling detected by TOE in the LAA and left atrium of a patient in AF.
Figure 2
Figure 2
Images acquired from intracardiac echocardiography (ICE). (A) Transeptal puncture with catheter (arrow) passing from right atrium to left atrium. (B) Colour flow mapping showing the confluence of the left upper and lower pulmonary veins (LUPV and LLPV). (C) Pulsed wave Doppler of the LAA showing preservation of velocities in a patient with AF. (D) Pulsed Doppler of the LUPV showing blunting of systolic (S) flow compared to diastolic (D) flow and a narrow atrial systolic reversal (AR) following cardioversion in the same patient.
Figure 3
Figure 3
Stenosis of the left upper pulmonary vein (LUPV) following radiofrequency ablation for AF. (A) Narrowing of the LUPV ostium (arrow) on multi-detector computed tomography. (B) Colour Doppler image from TOE demonstrating aliasing of flow in the LUPV. (C) Pulsed wave Doppler of the LUPV demonstrating phasic systolic (S) and diastolic (D) flow with increased velocities (> 1.5 m/s).
Figure 4
Figure 4
Percutaneous closure of the LAA. (A) Occluder device. (B) Fluoroscopic image of the occluder device in situ. (C) ICE image of the left atrium (LA) and LAA before deployment. (D) ICE following deployment of the device. Adapted and reproduced from Nakai et al, with permission.
Figure 5
Figure 5
Proposed algorithm for the approach to patients presenting with recent onset atrial fibrillation. *Patients with haemodynamic instability, acute coronary syndrome, or severe heart failure. †If anticoagulation with heparin (unfractionated or low molecular weight) is contraindicated, consider transoesophageal echo guided cardioversion and review contraindication to anticoagulation if thrombus detected. ‡If not high risk and <48 hours, no anticoagulation is needed. §High risk if recent left atrial appendage thrombus, prior thromboembolism, > 65 years old, heart failure, hypertension, left ventricular dysfunction, significant valve disease, left atrial dilatation, increased risk of haemorrhagic complications, or suboptimal anticoagulation. AF, atrial fibrillation; DC, direct current; Early CV, indication or preference for early cardioversion (see text); TOE, transoesophageal echocardiogram.
See this image and copyright information in PMC

References

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