From the Guidelines
You should be NPO for at least 6 hours before a TEE cardioversion to minimize the risk of aspiration. This is a crucial consideration because TEE involves inserting a probe down your esophagus while you're sedated, and having food or liquid in your stomach increases the risk of aspiration (inhaling stomach contents into your lungs) 1. The cardioversion part of the procedure, which delivers an electrical shock to reset your heart rhythm, requires sedation as well, further increasing aspiration risk.
Key Considerations
- The American College of Cardiology/American Heart Association guidelines do not specifically address NPO status for TEE cardioversion 1, but general anesthesia and sedation guidelines recommend NPO status to reduce aspiration risk.
- Your healthcare provider may give specific instructions about which medications to take or skip on the day of the procedure, such as blood thinners, which might need to be continued or temporarily stopped 1.
- It's essential to follow your doctor's personalized instructions regarding NPO status and medication management before your TEE cardioversion to ensure the procedure is both safe and effective.
Procedure Details
- Typically, you should not eat for 6 hours or drink clear liquids for 2 hours before the procedure.
- The TEE procedure itself, as mentioned in the guidelines, may be recommended for patients with certain conditions, such as mitral valve disease or hypertrophic cardiomyopathy, who have been on long-term anticoagulation 1.
- The decision to be NPO is based on the need to minimize risks associated with sedation and the procedure itself, rather than the specific details of the cardioversion or TEE guidelines 1.
From the Research
NPO Status for TEE Cardioversion
- The provided studies do not directly address the requirement of being NPO (nil per os, or nothing by mouth) for Transesophageal Echocardiography (TEE) cardioversion.
- However, TEE procedures typically require patients to be fasting or NPO for a certain period before the procedure to reduce the risk of aspiration and ensure patient safety during the procedure 2, 3, 4, 5, 6.
- The decision to require NPO status may depend on the specific clinical situation, the patient's health status, and the institution's policies.
- It is essential to follow the guidelines and recommendations of the healthcare institution and the medical team performing the TEE cardioversion procedure.
TEE Cardioversion Procedure
- TEE is used to guide cardioversion in patients with atrial fibrillation, allowing for the assessment of left atrial thrombi and the decision to proceed with cardioversion 2, 3, 4, 5, 6.
- The procedure involves the insertion of a transesophageal echocardiography probe into the esophagus to visualize the heart and its structures.
- The use of TEE has been shown to be safe and effective in guiding cardioversion and reducing the risk of thromboembolic events 2, 3.
Indications for TEE
- The indications for TEE before cardioversion for atrial fibrillation include symptomatic patients, those with congestive heart failure or hemodynamic compromise, and patients with high stroke risk 6.
- TEE is also used to evaluate patients with new-onset atrial fibrillation, hospitalized and symptomatic patients, and those with subtherapeutic anticoagulation 6.
- The main goal of TEE is to assess for left atrial thrombi and sludge, which can guide the decision to proceed with cardioversion and the need for anticoagulation therapy 2, 3, 4, 5, 6.