Introduction: Adequate oral anticoagulants (OACs) therapy is recommended before cardioversion if atrial fibrillation (AF) lasts ≥48 hours. Additional transoesophageal echocardiogram (TOE) is often performed before scheduled direct current cardioversion (DCC) even after proper anticoagulation.
Aims: To assess diagnostic value of TOE in properly anticoagulated patients with non-valvular AF; to establish possible additional indications for TOE; to evaluate the incidence of left atrial (LA) thrombi in appropriately anticoagulated patients in daily clinical practice.
Methods: Retrospective data analysis of patients with non-valvular AF, properly prepared with OACs before DCC. Thromboembolic (TE), bleeding risks were assessed using CHA2DS2-VASc and HAS-BLED scores. Transthoracic echocardiogram and TOE were evaluated. TE complications during 30 days after discharge were assessed.
Results: Were selected 432 patients, aged from 22 to 89 years (mean 65.0
±11.5); 277 (64.1%) males, 155 (35.9%) females; 306 (70.8%) on warfarin, 126
(29.2%) on direct oral anticoagulants (DOACs). Mean CHA2DS2-
VASc score 3.5 ±1.5. TOE was performed for 120 (27.8%), more
frequently for patients on DOACs and for ones with III° LA enlargement.
TOE revealed LA thrombi in 7 (5.8%) patients. In warfarin and DOACs
groups thrombi were revealed in 5 (7.0%) and 2 (4.1%) patients, respectively.
No thrombi in patients with normal left ventricular ejection fraction (LVEF); however, thrombi were found in 2 (6.1%) patients with slightly decreased LVEF, and in 5 (17.9%) patients with markedly decreased LVEF.
In patients with decreased LVEF thrombi in LA were found more frequently than in patients with normal and slightly decreased LVEF (17.9% vs 2.2%, p=0.008). CHA2DS2-VASc score of all 7 patients was ≥5.
There were no TE complications 30 days after discharge.
Conclusions: The risk of LA thrombi in patients prepared for scheduled DCC in
line with the guidelines is low. Higher risk of thrombi was present in patients with
decreased LVEF (≤40%), CHA2DS2-VASc ≥5.
