The role of transesophageal echocardiography in atrial fibrillation

Transesophageal echocardiography (TEE) is very useful in the evaluation and management of selected patients with atrial fibrillation, primarily by clear visualization of left atrial appendage thrombus. Insights gained from two-dimensional and Doppler interrogation of the appendage include recognition of the association of dense spontaneous contrast and reduced mechanical appendage function with increased risk of thromboembolism. TEE-guided cardioversion has been shown to be safe and effective for a subset of patients, provided it is performed by experienced operators familiar with imaging the appendage and recognizing artifacts.