• Beata Uziębło-Życzkowska, Marek Kiliszek, Iwona Gorczyca, Agnieszka Woronowicz-Chróściel, Bernadetta Bielecka, Paweł Wałek, Olga Jelonek, Beata Wożakowska-Kapłon, and Paweł Krzesiński.
• Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
• Pol. Arch. Med. Wewn. 2020 Oct 29; 130 (10): 837-843.

IntroductionAlthough guidelines endorse cardioversion after adequate non-vitamin K antagonist oral anticoagulant (NOAC) treatment without prior transesophageal echocardiography (TEE), the majority of patients still undergo this examination.ObjectivesThe aim of this study was to assess factors determining the decision to perform TEE in patients with atrial fibrillation (AF) who are eligible for elective cardioversion.Patients And MethodsIn this study, we evaluated the medical records of consecutive patients with AF who were admitted for elective cardioversion after prior NOAC treatment.ResultsOf a total of 668 patients included in the study, 362 individuals (54%) underwent TEE before cardioversion. In the univariable analysis, paroxysmal AF, hypertension, coronary artery disease (CAD), thromboembolic events, a history of percutaneous coronary intervention, a history of bleeding, left ventricular ejection fraction, left ventricular end‑ diastolic diameter, a reduced dose of NOACs, hemoglobin levels, impaired renal filtration, and a high CHA2DS2‑VASc score were significant predictors of the decision to perform TEE. In the multivariable logistic regression analysis, a history of CAD, bleeding, and stroke / transient ischemic attack / thromboembolism remained independent predictors of referring a patient 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 of refraining from TEE.ConclusionsTransesophageal echocardiography before cardioversion was more frequently performed in patients with a history of CAD, bleeding, or thromboembolic events. Patients with paroxysmal AF and hypertension more often received cardioversion without prior TEE.

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