Value of transesophageal echocardiography in the therapeutic management of non-valvular atrial fibrillation

Transoesophageal echocardiography (TOE) has transformed the management of atrial fibrillation. It has become the reference method for assessing thromboembolic risk and therefore the indication for anticoagulant therapy in non-valvular atrial fibrillation. The predictive factors of embolism are the presence of intraatrial spontaneous contrast echo or thrombosis, dilatation of the left atrial appendage (> 6 cm2) and reduced outflow velocities of the left atrial appendage (< 0.25 m/sec). The value of TOE before electrical cardioversion is under assessment. The predictive value of TOE in the success of cardioversion and maintenance of sinus rhythm at one year is subject of controversy. The projective ACUTE study (Assessment of Cardioversion Using Transoesophageal Echocardiography) should determine whether cardioversion guided by the results of TOE reduces the embolic risk and shortens the duration of anticoagulation before cardioversion.