National use of the transesophageal echocardiographic-guided approach to cardioversion for patients in atrial fibrillation

Transesophageal echocardiographic (TEE)-guided cardioversion of patients in atrial fibrillation (AF) of >2 days' duration is used as an alternative to conventional therapy. The purpose of this study was to investigate practic e patterns employed for stroke prophylaxis in patients with AF who underwen t cardioversion, and to determine the relative use of conventional and TEE- guided management strategies. We forwarded regionally stratified survey que stionnaires to 947 clinical practices within the United States. The 10-ques tion questionnaire queried demographic and clinical practice volumes and pr actices for managing patients with AF who underwent cardioversion. In addit ion, we used historical data to determine longitudinal use patterns of the TEE-guided approach for a large institution over 7 years. The 197 completed and returned surveys yielded a return rate of 20.8%. The TEE-guided approa ch was employed in approximately 12% of total cardioversions, but 75% of pr actices indicated that they employed transesophageal echocardiography only occasionally. The TEE-guided approach was associated with community size (r = 0.19; p <0.008), type of practice (r = 0.26; p = 0.001), total use of tr ansesophageal echocardiography (r = 0.48; p <0.001), and volume of cardiove rsions (r = 0.28; p <0.001). Importantly, there was little consensus on the most appropriate clinical indications for TEE-guided cardioversions, and t he proportions of TEE-guided cardioversion to total number of electrical ca rdioversions remained stable over 7 years. Practice volume and physician tr aining may be the most important variables in the adoption of the TEE appro ach. (C) 2000 by Excerpta Medica, Inc.