Echocardiography in atrial fibrillation (AF)

• transthoracic echocardiography (TTE) should be performed in patients with atrial fibrillation (AF):
  • for whom a baseline echocardiogram is important for long-term management, such as younger patients
  • for whom a rhythm-control strategy that includes cardioversion (electrical or pharmacological) is being considered
  • in whom there is a high risk or a suspicion of underlying structural/functional heart disease (such as heart failure or heart murmur) that influences their subsequent management (for example, choice of antiarrhythmic drug)
  • in whom refinement of clinical risk stratification for antithrombotic therapy is needed
• TTE should not be routinely performed solely for the purpose of further stroke risk stratification in patients with AF for whom the need to initiate anticoagulation therapy has already been agreed on appropriate clinical criteria
  
  
• transoesophageal echocardiography (TOE) should be performed in patients with AF:
  • when TTE demonstrates an abnormality (such as valvular heart disease) that warrants further specific assessment
  • in whom TTE is technically difficult and/or of questionable quality and where there is a need to exclude cardiac abnormalities
  • for whom TOE-guided cardioversion is being considered.

Reference:

1. NICE (June 2014). Atrial Fibrillation - the management of atrial fibrillation