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open access

Vol 30, No 4 (2023)
Review Article
Submitted: 2021-05-06
Accepted: 2021-08-05
Published online: 2021-10-18
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Is transesophageal echocardiography necessary before electrical cardioversion in patients treated with non-vitamin K antagonist oral anticoagulants? Current evidence and practical approach

Iwona Gorczyca12, Beata Uziębło-Życzkowska3, Paweł Krzesiński3, Agnieszka Major12, Agnieszka Kapłon-Cieślicka4
DOI: 10.5603/CJ.a2021.0129
·
Pubmed: 34671967
·
Cardiol J 2023;30(4):646-653.
Affiliations
  1. Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
  2. 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Kielce, Poland
  3. Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
  4. 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland

open access

Vol 30, No 4 (2023)
Review articles — Clinical cardiology
Submitted: 2021-05-06
Accepted: 2021-08-05
Published online: 2021-10-18

Abstract

According to current guidelines, non-vitamin K antagonist oral anticoagulants (NOACs) should be used
at least 3 weeks before planned electrical cardioversion. In accordance with international atrial fibrillation
(AF) guidelines, transesophageal echocardiography (TEE) is a pre-procedural examination recommended
as an alternative to adequate oral anticoagulation. The strategy related to qualifying patients
treated with NOACs for pre-procedural TEE differs in individual centers. Therefore, it is necessary to
create an algorithm that will standardize estimation of left atrial appendage thrombus (LAAT) prevalence
risk and thereby qualify NOAC-treated patients to TEE in the most effective way. We assessed the
available studies on LAAT predictors. Risk factors for LAAT formation are not necessarily the same as
the risk factors for thromboembolic events in patients with AF. The main risk factor for LAAT are as follows:
previous intracardiac thrombus, irregular use of NOAC, inappropriate dose reduction of NOAC,
previous stroke, CHA2DS2-VASc score ≥ 3 points, glomerular filtration rate < 60 mL/min/1.73 m2,
reduced left ventricular ejection fraction, or left atrial enlargement. Based on available evidence, we
proposed algorithm guarantees more systematic approach to performing TEE in patients undergoing
electrical cardioversion.

Abstract

According to current guidelines, non-vitamin K antagonist oral anticoagulants (NOACs) should be used
at least 3 weeks before planned electrical cardioversion. In accordance with international atrial fibrillation
(AF) guidelines, transesophageal echocardiography (TEE) is a pre-procedural examination recommended
as an alternative to adequate oral anticoagulation. The strategy related to qualifying patients
treated with NOACs for pre-procedural TEE differs in individual centers. Therefore, it is necessary to
create an algorithm that will standardize estimation of left atrial appendage thrombus (LAAT) prevalence
risk and thereby qualify NOAC-treated patients to TEE in the most effective way. We assessed the
available studies on LAAT predictors. Risk factors for LAAT formation are not necessarily the same as
the risk factors for thromboembolic events in patients with AF. The main risk factor for LAAT are as follows:
previous intracardiac thrombus, irregular use of NOAC, inappropriate dose reduction of NOAC,
previous stroke, CHA2DS2-VASc score ≥ 3 points, glomerular filtration rate < 60 mL/min/1.73 m2,
reduced left ventricular ejection fraction, or left atrial enlargement. Based on available evidence, we
proposed algorithm guarantees more systematic approach to performing TEE in patients undergoing
electrical cardioversion.

Full Text:

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Keywords

electrical cardioversion, non-vitamin K antagonist oral anticoagulant, transesophageal echocardiography

About this article
Title

Is transesophageal echocardiography necessary before electrical cardioversion in patients treated with non-vitamin K antagonist oral anticoagulants? Current evidence and practical approach

Journal

Cardiology Journal

Issue

Vol 30, No 4 (2023)

Article type

Review Article

Pages

646-653

Published online

2021-10-18

Page views

3002

Article views/downloads

579

DOI

10.5603/CJ.a2021.0129

Pubmed

34671967

Bibliographic record

Cardiol J 2023;30(4):646-653.

Keywords

electrical cardioversion
non-vitamin K antagonist oral anticoagulant
transesophageal echocardiography

Authors

Iwona Gorczyca
Beata Uziębło-Życzkowska
Paweł Krzesiński
Agnieszka Major
Agnieszka Kapłon-Cieślicka

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