From the Guidelines
Patients with atrial fibrillation (a fib) should undergo echocardiography at the time of diagnosis, but routine follow-up echocardiograms are not recommended unless there is a change in clinical status. The initial echocardiogram is essential to assess for structural heart disease, left ventricular function, left atrial size, and valvular abnormalities, which help guide treatment decisions regarding rate control, rhythm control, and anticoagulation 1. This baseline assessment also helps identify potential causes of a fib such as heart failure or valvular disease.
Key Points for Echocardiography in Atrial Fibrillation
- Echocardiography should be performed to assess cardiac structure and function 1
- Maximal left atrial volume indexed to body surface area is recommended for quantification of left atrial size 1
- Left atrial strain can be reliably imaged and used as a surrogate of left atrial wall fibrosis 1 For ongoing management, repeat echocardiography is indicated only when there are new symptoms, signs of heart failure, changes in cardiac examination, consideration of rhythm control strategies like cardioversion or ablation, or suspected progression of valvular disease. The rationale for selective rather than routine follow-up imaging is that management changes are typically driven by clinical changes rather than echocardiographic findings alone in stable patients 1. Additionally, unnecessary routine imaging increases healthcare costs without providing significant clinical benefit for most stable a fib patients.
From the Research
Echocardiography in Atrial Fibrillation
- Echocardiography plays a significant role in the evaluation and management of atrial fibrillation (a fib) [(2,3,4,5)].
- It allows for the assessment of cardiac structure and function, including the detection of thrombi and the evaluation of thromboembolic risk [(2,5)].
- Transthoracic echocardiography is recommended for all patients with a fib, while transesophageal echocardiography may be used in specific situations, such as before electrical cardioversion 2.
Routine Echocardiography in New-Onset Atrial Fibrillation
- The value of routine echocardiography in new-onset a fib has been debated, with some studies suggesting that it may not be necessary in all cases 6.
- A study from 1987 found that routine echocardiography added little to a careful clinical examination in patients with new-onset a fib 6.
- However, more recent studies have highlighted the importance of echocardiography in the evaluation and management of a fib, particularly in patients with underlying cardiac conditions [(2,3,4,5)].
Advanced Echocardiography Techniques
- Advanced echocardiography techniques, such as speckle-tracking and three-dimensional echocardiography, can provide additional information on cardiac structure and function in patients with a fib [(3,4)].
- These techniques can help to identify patients with significant cardiac remodeling and dysfunction, and may be useful in guiding treatment decisions 3.