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

According to current guidelines, non-vitamin K antagonist oral anticoagulants (NOACs) should be usedat least 3 weeks before planned electrical cardioversion. In accordance with international atrial fibrillation(AF) guidelines, transesophageal echocardiography (TEE) is a pre-procedural examination re...

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Bibliographic Details
Published in:Cardiology journal 2023-08, Vol.30 (4), p.646-653
Main Authors: Gorczyca, Iwona, Uziębło-Życzkowska, Beata, Krzesiński, Paweł, Major, Agnieszka, Kapłon-Cieślicka, Agnieszka
Format: Article
Language:English
Subjects:
Anticoagulants
Blood clots
Cardioversion
Clinical Cardiology
Online Access:Get full text
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Summary:According to current guidelines, non-vitamin K antagonist oral anticoagulants (NOACs) should be usedat least 3 weeks before planned electrical cardioversion. In accordance with international atrial fibrillation(AF) guidelines, transesophageal echocardiography (TEE) is a pre-procedural examination recommendedas an alternative to adequate oral anticoagulation. The strategy related to qualifying patientstreated with NOACs for pre-procedural TEE differs in individual centers. Therefore, it is necessary tocreate an algorithm that will standardize estimation of left atrial appendage thrombus (LAAT) prevalencerisk and thereby qualify NOAC-treated patients to TEE in the most effective way. We assessed theavailable studies on LAAT predictors. Risk factors for LAAT formation are not necessarily the same asthe 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, weproposed algorithm guarantees more systematic approach to performing TEE in patients undergoingelectrical cardioversion.
ISSN:1897-5593
1898-018X
DOI:10.5603/CJ.a2021.0129