TEE screening in atrial flutter: a single-centre experience with retrospective validation of a new risk score for the presence of atrial thrombi |
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Authors: | Gaibazzi Nicola Piepoli Massimo |
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Affiliation: | aAzienda Ospedaliero-Universitaria di Parma-Cardiology, Ospedale “Guglielmo da Saliceto”-Piacenza, Via Gramsci, 14, Parma, Italy |
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Abstract: | Transesophageal echocardiography (TEE) has been proposed as a screening tool to exclude the presence of atrial thrombi and left atrial spontaneous echocontrast before cardioverting persistent atrial flutter (AFl) and atrial fibrillation (AF). However in pure AFl a very low prevalence of atrial thrombi has been observed by many investigators: a confirmation of this finding would make TEE screening redundant.We review our database of patients with AFl who underwent TEE screening before cardioversion in the last 5 years. A new risk score for the presence of left atrial thrombus (AFLAT score) is here proposed, as a potential tool to avoid unnecessary TEE exams.Out of the 106 patients examined, in fourteen left atrial thrombi were diagnosed (13%). Only two cases belonged to the pure AFl subgroup (prevalence = 3%), while twelve cases were detected in the subgroup of AFl patients with previous AF episodes (prevalence = 32%, p < 0.001).All of the fourteen patients with a positive TEE for thrombus were identified by a AFLAT score > 2. The validation of this index in a larger and prospective setting would lead to a 85% reduction in unnecessary TEE exams in patients with pure AFl undergoing cardioversion. |
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Keywords: | Atrial flutter TEE Echocardiography Thrombi |
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