TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN NONRH EUMATIC ATRIAL-FIBRILLATION- A MODERATELY SENSITIVE METHOD TO EVALUATE THE RISK OF CEREBROVASCULAR COMPLICATIONS

120 consecutive unselected patients with chronic non-rheumatic atrial fibrillation without anticoagulant therapy were examined by transthora cic and transoesophageal echocardiography. Patients with a history of an ischaemic cerebrovascular event (n = 41) had left atrial thrombi, s pontaneous contrast or both significantly more often (n = 25, 61%) tha n patients in the control group (24/79 = 30%). However, when compared with controls, patients with a history of cerebrovascular events were also older. and had hypertension and left ventricular disease (ejectio n fraction < 45%) more often. Abnormal carotid duplex scans were also very common in this group (71%). Transoesophageal echocardiography is useful for evaluating the risk of cerebrovascular complications in non -rheumatic atrial fibrillation. However, the method is quite insensiti ve (61%) and therefore insufficient as the sole parameter for deciding the need for anticoagulation. It is likely that cerebrovascular compl ications in these polymorbid patients are partially caused by other fa ctors than embolism from the left atrium.