2001 ACUTE TRIAL Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation multicenter, prospective, randomized controlled trial Objective: To compare conventional anticoagulation strategy with the transesophageal echocardiography to guide short-term anticoagulant therapy in patients with atrial fibrillation prescribed with electrical cardioversion 1222 patients Inclusion criteria: Patients aged ≥18 years who had atrial fibrillation of more than 2 days duration or who had atrial flutter with history of atrial fibrillation. M 0.8 TEE-guided cardioversion (n=619) PRIMARY OUTCOME Conventional treatment (n=603) Composite of cerebrovascular acci- dent, transient ischemic attack, and peripheral embolism at 8 weeks % RR 1.62; 95% CI, 0.39 to 6.76; P=0.50 SECONDARY OUTCOME Hemorrhagic events% 0.5 2.9 5.5 RR 0.53; 95% CI, 0.30 to 0.93; P=0.03 Deaths from all causes % 2.4 1.0 RR 2.44; 95% CI, 0.95 to 6.24; P=0.06 Sinus rhythm restored 71.1 within 8 weeks % 65.2 RR 1.09; 95% CI, 1.01 to 1.18; P=0.03 27.4 Functional status at 8 weeks-DASI score P=0.50 26.7 Conclusion: The use of transesophageal echocardiography to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned. AL Klein et al. NEJM 2001; 344:1411-1420 |Visualmed