Atrial fibrillation echocardiography or ultrasound
Jump to navigation
Jump to search
 |
Resident Survival Guide |
| File:Critical Pathways.gif |
Sinus rhythm  |
Atrial fibrillation  |
|
Atrial Fibrillation Microchapters | |
|
Special Groups | |
|---|---|
|
Diagnosis | |
|
Treatment | |
|
Cardioversion | |
|
Anticoagulation | |
|
Surgery | |
|
Case Studies | |
|
Atrial fibrillation echocardiography or ultrasound On the Web | |
|
Atrial fibrillation echocardiography or ultrasound in the news | |
|
Directions to Hospitals Treating Atrial fibrillation echocardiography or ultrasound | |
|
Risk calculators and risk factors for Atrial fibrillation echocardiography or ultrasound | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Anahita Deylamsalehi, M.D.[3]
Overview
Performing an echocardiogram in the setting of atrial fibrillation is essential to identify certain characteristics of the heart, including valvular heart disease, hypertrophy, presence of thrombus, the size and function of the left ventricle, the size of the atria, and the possible presence of pericardial disease. transesophageal echocardiogram is more sensitive, compared to the transthoracic echocardiography. Echocardiography is essential to identify some of the characteristics in the setting of atrial fibrillation, such as valvular heart disease, atrial size, left ventricle (LV) size and function, and peak right ventricle pressure (pulmonary hypertension).
Echocardiography
- Echocardiography is essential to identify the following characteristics in the setting of atrial fibrillation:[1][2]
- Valvular heart disease
- Left and right atrial size
- Left ventricle (LV) size and function
- Peak right ventricle pressure (pulmonary hypertension)
- Left ventricular hypertrophy
- Left atrium thrombus (low sensitivity)
- Pericardial disease
- Based on a study done on 486 patients with atrial fibrillation, some of the echocardiographic features can work as predictors.[3]
- Detecting left atrium enlargement could be associated with the recurrent intermittent atrial fibrillation (AF)
- Detecting left ventricle could be associated with transformation to the constant atrial fibrillation (AF)
- Left atrial appendage thrombus could be even seen in patients with acute atrial fibrillation, similar to chronic cases.
Transesophageal Echocardiography (TEE)
- A normal echocardiography (transthoracic or TTE) has a low sensitivity for identifying thrombi (blood clots) in the heart. If atrial fibrillation is suspected and urgent electrical cardioversion is planned a transesophageal echocardiogram (TEE) is preferred.[4]
- The TEE has much better visualization of the left atrial appendage than transthoracic echocardiography. This structure, located in the left atrium, is the place where thrombus most commonly is formed in the setting of atrial fibrillation or atrial flutter. TEE has a very high sensitivity for locating thrombus in this area and can also detect sluggish blood flow in this area that is suggestive of thrombus formation.
- If no thrombus is seen on TEE, the incidence of stroke immediately after cardioversion is very low.
- The following are indications of transesophageal echocardiography (TEE) in atrial fibrillation patients, based on NICE guideline: [5]
- When an abnormal condition, such as valvular heart disease has been detected on transthoracic echocardiography and further investigation is required
- When performing transthoracic echocardiography is not possible or when the findings of it is not absolutely clear
- When TOE-guided cardioversion is considered
Transthoracic Echocardiography (TTE)
- A transthoracic echocardiogram is generally performed in newly diagnosed atrial fibrillation (AF), as well as if there is a major change in patient's clinical state. This ultrasound-based scan of the heart may help identify valvular heart disease (which may increase the risk of stroke), left and right atrial size (which indicates likelihood of atrial fibrillation changing into the permanent type), left ventricular size and dysfunction, peak right ventricular pressure (pulmonary hypertension), presence of left ventricular hypertrophy and pericardial disease.[4]
- Significant enlargement of both the left and right atria is associated with long-standing atrial fibrillation and, if noted at the initial presentation of atrial fibrillation, suggests that the atrial fibrillation is likely of a longer duration than the individual's symptoms.
- Indications of transthoracic echocardiogram in atrial fibrillation patients, based on NICE guideline: [5]
- As a baseline echocardiogram for prolonged management
- If treatment strategies such as cardioversion (both electrical and pharmacological) has been considered
- When conditions such as structural heart disease or functional heart disease (which may present with heart failure or heart murmur is suspected
- When clarification of clinical risk stratification is required for antithrombotic therapy
References
- ↑ Vaziri SM, Larson MG, Benjamin EJ, Levy D (1994). "Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study". Circulation. 89 (2): 724–30. doi:10.1161/01.cir.89.2.724. PMID 8313561.
- ↑ Keren G, Etzion T, Sherez J, Zelcer AA, Megidish R, Miller HI; et al. (1987). "Atrial fibrillation and atrial enlargement in patients with mitral stenosis". Am Heart J. 114 (5): 1146–55. doi:10.1016/0002-8703(87)90190-6. PMID 2960225.
- ↑ Flaker GC, Fletcher KA, Rothbart RM, Halperin JL, Hart RG (1995). "Clinical and echocardiographic features of intermittent atrial fibrillation that predict recurrent atrial fibrillation. Stroke Prevention in Atrial Fibrillation (SPAF) Investigators". Am J Cardiol. 76 (5): 355–8. doi:10.1016/s0002-9149(99)80100-3. PMID 7639159.
- ↑ 4.0 4.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ 5.0 5.1 Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check
|pmid=value (help).