Atrial fibrillation echocardiography or ultrasound: Difference between revisions
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{{Template:Atrial fibrillation}} | {{Template:Atrial fibrillation}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} {{Anahita}} | ||
==Overview== | ==Overview== | ||
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==Echocardiography== | ==Echocardiography== | ||
Echocardiography is essential to identify the following characteristics in the setting of atrial fibrillation: | [[Echocardiography]] is essential to identify the following characteristics in the setting of [[atrial fibrillation]]: | ||
* [[Valvular heart disease]] | * [[Valvular heart disease]] | ||
* Left and right atrial size | * Left and right [[atrium|atrial]] size | ||
* LV size and function | * [[Left ventricle]] ([[Left ventricle|LV]]) size and function | ||
* Peak | * Peak [[right ventricle]] [[pressure]] ([[pulmonary hypertension]]) | ||
*[[ | *[[Left ventricular hypertrophy]] | ||
* | * [[Left atrium]] [[thrombus]] (low [[Sensitivity (tests)|sensitivity]]) | ||
* Pericardial disease | * [[Pericarditis|Pericardial disease]] | ||
===Transesophageal Echocardiography (TEE)=== | ===Transesophageal Echocardiography (TEE)=== | ||
*A normal [[echocardiography]] (transthoracic or TTE) has a low sensitivity for identifying [[thrombus|thrombi]] (blood clots) in the heart. | *A normal [[echocardiography]] ([[Standard views and measurements in transthoracic echocardiography|transthoracic]] or [[Echocardiography|TTE]]) has a low [[Sensitivity (tests)|sensitivity]] for identifying [[thrombus|thrombi]] ([[Thrombus|blood clots]]) in the [[heart]]. If [[atrial fibrillation]] is suspected and urgent electrical [[cardioversion]] is planned a [[Echocardiogram#Transesophageal echocardiogram|transesophageal echocardiogram]] ([[Echocardiography|TEE]]) is preferred.<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref> | ||
*The TEE has much better visualization of the [[left auricular appendix|left atrial appendage]] than transthoracic echocardiography. | *The [[Echocardiography|TEE]] has much better visualization of the [[left auricular appendix|left atrial appendage]] than [[Echocardiography|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]]. [[Echocardiography|TEE]] has a very high [[Sensitivity (tests)|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 | *If no [[thrombus]] is seen on [[Echocardiography|TEE]], the incidence of [[stroke]] immediately after [[cardioversion]] is very low. | ||
===Transthoracic Echocardiography (TTE)=== | ===Transthoracic Echocardiography (TTE)=== | ||
*A [[Transthoracic echocardiography|transthoracic echocardiogram]] is generally performed in newly diagnosed [[AF]], as well as if there is a major change in | *A [[Transthoracic echocardiography|transthoracic echocardiogram]] is generally performed in newly [[diagnosis|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]]), [[atrium|left and right atrial]] size (which indicates likelihood of [[atrial fibrillation]] changing into the permanent type), [[left ventricle|left ventricular size]] and dysfunction, peak [[right ventricle|right ventricular pressure]] ([[pulmonary hypertension]]), presence of [[left ventricular hypertrophy]] and [[Pericarditis|pericardial disease]].<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref> | ||
*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. | *Significant enlargement of both the [[atrium|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]]. | ||
==References== | ==References== | ||
Revision as of 20:04, 1 August 2021
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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.
Echocardiography
Echocardiography is essential to identify the following characteristics in the setting of atrial fibrillation:
- 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
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.[1]
- 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.
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.[1]
- 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.
References
- ↑ 1.0 1.1 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