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Transesophageal Echocardiography and Atrial Fibrillation: Added Value or Expensive Toy?

Warren J. Manning, MD; and Pamela S. Douglas, MD
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Beth Israel Deaconess Medical Center; Boston, MA 02215 Requests for Reprints: Pamela S. Douglas, MD, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. Current Author Addresses: Drs. Manning and Douglas: Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(8):685-687. doi:10.7326/0003-4819-128-8-199804150-00013
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Atrial fibrillation, the most common type of sustained arrhythmia, is associated with considerable morbidity and mortality from stroke and systemic thromboembolism. Several large, randomized, multicenter studies have documented that systemic warfarin anticoagulation reduces thromboembolic complications associated with atrial fibrillation by two thirds [12], presumably because of warfarin's efficacy in inhibiting thrombus formation within the stagnant left atrial appendage. Long-term warfarin therapy, however, is associated with the cost and inconvenience of monitoring and high morbidity and mortality. These effects are especially prevalent among elderly persons, a population at high risk for thromboembolic complications of atrial fibrillation [3]. The identification of subgroups at high and low risk for thromboembolism and further understanding of the mechanism of thromboembolism in persons with atrial fibrillation would therefore be valuable.

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