ECHO 2013 / Advanced TEE Clinical Decision Making in Cryptogenic Stroke and Atrial Fibrillation
.pdfCHA2DS2-VASc Score
C |
= |
Congestive heart failure |
1 |
H |
= |
Hypertension |
1 |
A |
= Age ≥ 75 years |
2 |
|
D |
= |
Diabetes |
1 |
S |
= |
Stroke or TIA |
2 |
V |
= |
Vascular disease (MI, PAD, arch plaque) |
1 |
A |
= |
Age 65-74 |
1 |
Sc |
= |
Sex category (female) |
1 |
0 = |
Low risk (1% per year) |
Lip et al, Chest 2010;13:285, 2864-70
TEE-Guided Electrical Cardioversion (CV)
ACUTE Study
•1022 patients with atrial fibrillation >2 days
•603 conventional treatment (3 weeks of oral anticoagulation before CV), 609 TEE-guided strategy
•4 weeks of oral anticoagulation after CV
•Primary outcome: embolic events within 8 weeks
• |
Time to CV: |
30.6 |
vs. |
3.0 days |
(p<0.001) |
• |
Successful CV: |
65.2% |
vs. |
71.1% |
(p=0.03) |
• |
Hemorrhagic events: |
5.5% |
vs. |
2.9% |
(p=0.03) |
• |
Embolic events: |
0.5% |
vs. |
0.8% |
(p=0.5) |
Klein et al, N Engl J Med 2001;344:1411-20
TEE in Atrial Fibrillation - Conclusion
•TEE is an important tool in the assessment of the individual risk of stroke in patients with atrial fibrillation, with important implications for their medical management, especially in patients considered at intermediate risk on the basis of their risk score (CHADS2)
•TEE may also shorten the time of anticoagulation needed before cardioversion, with an associated increase in success rate in restoring sinus rhythm and a decrease in hemorrhagic complications