Although guidelines allow cardioversion after adequate non-vitamin K antagonist oral anticoagulant (NOAC) treatment without prior transesophageal echocardiography (TEE), the majority of patients still undergo this examination.
The aim of this study was to assess the factors determining the decision to perform TEE in patients with atrial fibrillation (AF) who are qualified for elective cardioversion.
In this study, we evaluated the medical data of consecutive patients with AF who were admitted for cardioversion after being previously treated with NOACs.
Of a total of 668 patients included in the study, 362 (54%) underwent TEE before cardioversion. In a univariable analysis, paroxysmal AF, hypertension, coronary disease, thromboembolic event, a history of percutaneous coronary intervention, a history of bleeding, left ventricular (LV) ejection fraction, LV end-diastolic diameter, a reduced dose of NOACs, hemoglobin, impaired renal filtration, and a high CHA2DS2VASc score were significant predictors of the decision to perform TEE. In the multivariable logistic regression analysis, a history of coronary disease, bleeding, and stroke/transient ischemic attack (TIA)/thromboembolism remained independent predictors of a patient qualifying for TEE (odds ratio [OR] 3.92; P < 0.001; OR 7.92; P < 0.001 and OR 2.36; P = 0.02, respectively). In contrast, paroxysmal AF (OR 0.31; P = 0.02) and hypertension (OR 0.28; P < 0.001) were indicators to avoid TEE.
TEE before cardioversion was more frequent in patients with a history of coronary disease, bleeding, or thromboembolic event. Patients with paroxysmal AF and hypertension more often received cardioversion without prior TEE.