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Role of echocardiography in atrial fibrillation

Warren J Manning, MD
Section Editor
Bradley P Knight, MD, FACC
Deputy Editor
Brian C Downey, MD, FACC


The role of echocardiographic imaging among patients with atrial fibrillation (AF) can be divided into several categories:

Assessment of cardiac chamber sizes and function, the atrial contribution to left ventricular filling, the pericardium, and valvular function. This information may be helpful in determining the conditions associated with AF, the risk for recurrent AF following cardioversion, and the hemodynamic benefit of maintaining sinus rhythm. (See "Epidemiology of and risk factors for atrial fibrillation" and "Antiarrhythmic drugs to maintain sinus rhythm in patients with atrial fibrillation: Recommendations".)

Identification of patients at increased risk for thromboembolic complications of AF before cardioversion and in patients with chronic AF. (See "Prevention of embolization prior to and after restoration of sinus rhythm in atrial fibrillation" and "Atrial fibrillation: Risk of embolization".)

Nearly all patients presenting with their first episode of AF will benefit from transthoracic (surface) echocardiographic (TTE) evaluation of left atrial size, left ventricular systolic function, and mitral valve morphology and function. A more selected subgroup may benefit from the additional information obtained from transesophageal echocardiographic (TEE) evaluation for left atrial thrombi to allow for early cardioversion if no thrombi are identified. Comparison with a prior TTE (if available) may allow for assessment of the atrial contribution to left ventricular filling when the patient is in sinus rhythm. (See "Management of new onset atrial fibrillation".)

Studies from the Stroke Prevention in Atrial Fibrillation (SPAF) investigators confirmed the usefulness of transesophageal echocardiography (TEE) for predicting thromboembolism [1,2]. This study involved 786 patients with nonrheumatic AF, 382 of whom were at high clinical risk for a thromboembolism (eg, women >75 years of age and patients with systolic blood pressure >160 mmHg or a history of previous thromboembolism, impaired left ventricular function, or recent congestive heart failure). The rate of stroke was increased over threefold when TEE evidence of dense spontaneous echocontrast was present, increased by threefold for reduced (<20 cm/second) left atrial appendage peak ejection flow velocity and for left atrial appendage thrombus, and increased by fourfold by complex aortic plaque.


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Literature review current through: Sep 2016. | This topic last updated: Mar 7, 2016.
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