ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE DETECTION OF LEFT ATRIAL THROMBUS IN PATIENTS WITH CHRONIC NONRHEUMATIC ATRIAL-FIBRILLATION

Transesophageal echocardiography was used to assess cardiac abnormalit ies associated with embolization in patients who had completed the Dep artment of Veterans Affairs Cooperative Study of Stroke Prevention in Nonrheumatic Atrial Fibrillation at the Minneapolis and West Haven Dep artment of Veterans Affairs Medical Centers without an embolic event. Patients were men, 71 +/- 7 years old, with atrial fibrillation of 6.2 +/- 4.3 years' duration who had received warfarin (n = 32) or placebo (n = 23) for 2 years. Thrombi were found in 5 of 55 patients (warfari n 4 and placebo 1; p = 0.39); spontaneous echo contrast was seen in 4 of 5 patients. Other abnormalities identified included spontaneous ech o contrast (47%), patent foramen ovale (54%), atrial septal aneurysm ( 7.3%), and left ventricular thrombus (3.6%). During 34 months of postt reatment follow-up, 5 patients had a stroke (1 fatal), and 10 died. Po tential sources of emboli did not predict subsequent outcome. Thus war farin therapy did not preclude the presence of thrombi. Stroke reducti on likely involves the prevention of emboli from sources in addition t o the atrial appendage.