Transesophageal Echocardiography and Cardioversion Trends in Patients with Atrial Fibrillation: A 10-Year Survey

Background Transesophageal echocardiography (TEE) has long been used to assess for left atrial thrombus (LAT) in patients undergoing direct-current cardioversion (DCC) for atrial fibrillation or flutter. However, little is known about its recent trends and current applications. Methods In this retrospective study, 3,191 serial transesophageal echocardiographic studies in 2,705 unique patients (mean age, 66 ± 13 years; 68% men) with atrial fibrillation or atrial flutter who underwent TEE before DCC from 1999 to 2008 were identified using the Cleveland Clinic echocardiography database. Clinical data and information on the presence of spontaneous echocardiographic contrast, sludge, or LAT before DCC were obtained as well as the total number of transesophageal echocardiographic studies and DCC procedures performed in outpatient or inpatient settings. Results Increasing trends of TEE-guided DCC were observed over the past 10 years (25% in 1999, 34% in 2008). TEE-guided DCC was also performed more often in the outpatient setting (21% in 1999, 37% in 2008). There was no yearly difference for the prevalence of LAT or sludge (8% overall; P = .12). Conclusions Over the past 10 years, trends have suggested that the application of TEE-guided DCC compared with the conventional approach have consistently grown and that more DCC procedures are done in the outpatient setting. Given the high LAT or sludge detection rate of 8%, TEE-guided DCC has continued to be an important part of atrial fibrillation management.