In this Mayo Clinic Grand Rounds video, Michael W. Cullen, M.D., discusses transesophageal echocardiography, risk factors for left atrial appendage thrombus and atrial appendage intervention.

In summary, as the first prospective study to evaluate the use of LMWH in TEE-guided cardioversion this is a landmark study. There are significant limitations of the study that affect its interpretation and application and therefore, more studies are needed to confirm the efficacy and safety of LMWH use in TEE-guided cardioversion. References: 1. TEE-guided Anticoagulation in Patients Undergoing Electrical Cardioversion of Atrial Fibrillation: Results From the ACUTE Registry. Journal of the American College of Cardiology, 1998. Deborah Agler. James Thomas. richard grimm. S. Vaughn. Allan Klein. 5. Patients who undergo TEE guided DCCV should be anti-coagulated at the time of TEE guided DCCV. It is recommended to start anticoagulation at the time the decision was made to proceed with TEE guided Cardioversion. a. Started on Warfarin and IV heparin with therapeutic level prior to TEE/cardioversion and continued until INR >2.0 i. The TEE-guided approach to cardioversion used by experts is safe, as shown by Manning and colleagues .The ACUTE Pilot Study compared the TEE-guided approach with the conventional approach to cardioversion. In my editorial, I suggested that a larger-scale clinical trial should provide valuable data about the risk for thromboembolism. Electrical cardioversion- the rhythm reset. Electrical cardioversion is a procedure in which a patient receives an electrical shock on the outside of the chest (while under mild anesthesia) using either paddles or patches. The shock can be used to "reset" the heart to a normal rhythm. The procedure is similar to defibrillation, but uses much lower levels of electricity. TEE Before Cardioversion of AF. Abstract & Commentary. By Michael H. Crawford, MD, Editor. Source: Grewal GK, et al. Indications for TEE befo