Atrial fibrillation echocardiography or ultrasound
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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]
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.
- LV size and function.
- Peak RV pressure (pulmonary hypertension).
- LV hypertrophy.
- LA 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 this is suspected, e.g. when planning urgent electrical cardioversion 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 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 performed is very low.
Transthoracic echocardiography (TTE)
A transthoracic echocardiogram is generally performed in newly diagnosed AF, as well as if there is a major change in the patient's clinical state. This ultrasound-based scan of the heart may help identify valvular heart disease (which may increase the risk of stroke manifold), left and right atrial size (which indicates likelihood that AF may become permanent), left ventricular size and function, 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