OROPHARYNX PAIN, DISCOMFORT, AND ECONOMIC IMPACT OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PATIENTS WITH ATRIAL FIBRILLATION
Article Information
Download Article
How to Cite
Abstract
Transesophageal echocardiography (TEE) plays an essential role in detecting left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF), aiding clinical decisions regarding catheter ablation. However, this procedure may induce anxiety, discomfort, and sore throat in patients. This cross-sectional study aimed to evaluate patient experiences related to TEE and its economic implications in AF management. A total of 108 patients with AF undergoing TEE at the Department of Cardiology, Thong Nhat Hospital, were enrolled. The prevalence of LAA thrombus was 13.8%. Patients with thrombus had significantly higher body mass index (BMI) and lower LAA emptying velocity (p < 0.05). Moderate-to-severe anxiety was observed in 38.9% of patients, while 41.6% reported moderate-to-severe sore throat. Factors significantly associated with anxiety included current employment status, hemodynamic control, and coexisting cardiovascular diseases. Higher educational level and cardiovascular comorbidities were associated with less severe sore throat. Discomfort in the oropharyngeal region was reported by 76.9% of patients, though no significant predictors were identified. Outpatient TEE was associated with a statistically significant reduction in hospital stay by an average of 2.8 days (p = 0.048). Although TEE is a necessary diagnostic tool, it may cause considerable discomfort for patients. Adequate hemodynamic control, patient counseling, and implementing outpatient TEE strategies may improve patient experience and healthcare efficiency.
Keywords
References
- Daniel WG, Mügge A. Transesophageal echocardiography. N Engl J Med.1995;332:1268-1279. DOI: https://doi.org/10.1056/NEJM199505113321906
- Nishikii-Tachibana M, Murakoshi N, Seo Y, et al. Prevalence and clinical determinants of left atrial appendage thrombus in patients with atrial fibrillation before pulmonary vein isolation. Am J Cardiol. 1995;116:1368–1373. DOI: https://doi.org/10.1016/j.amjcard.2015.07.055
- Dhariwal A, Plevris JN, Lo NT, Finlayson ND, Heading RC, Hayes PC. Age, anemia, and obesity-associated oxygen desaturation during upper gastrointestinal endoscopy. Gastrointest Endosc. 1992;38:684–688. DOI: https://doi.org/10.1016/S0016-5107(92)70564-1
- Rostykus PS, McDonald GB, Albert RK. Upper intestinal endoscopy induces hypoxemia in patients with obstructive pulmonary disease. Gastroenterology. 1980;78:488–491. DOI: https://doi.org/10.1016/0016-5085(80)90861-6
- Yazawa K, Adachi W, Koide N, et al. Changes in cardiopulmonary parameters during upper gastrointestinal endoscopy in patients with heart disease: towards safer endoscopy. Endoscopy. 2000;32:287–293. DOI: https://doi.org/10.1055/s-2000-7377
- Coisne A, Dreyfus J, Bohbot Y, et al. Transoesophageal echocardiography current practice in France: a multicentre study. Arch Cardiovasc Dis. 2018;111:730–738. DOI: https://doi.org/10.1016/j.acvd.2018.03.014
- Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155(12):2545-2550. DOI: https://doi.org/10.1016/j.pain.2014.09.014
- Calkins H, Hindricks G, Cappato R, et al. HRS/ EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. Europace. 2018;20:1-208. DOI: https://doi.org/10.1093/europace/eux274
- Nguyễn Anh Vũ. Siêu âm Tim từ căn bản đến nâng cao. Nhà Xuất Bản Đại Học Huế. 2018
- Hahn RT, Abraham T, Adam MS. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26(9):921-964. DOI: https://doi.org/10.1016/j.echo.2013.07.009
- Manning WJ, Silverman DI, Gordon SP, Krumholz HM, Douglas PS. Cardioversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude the presence of atrial thrombi. N Engl J Med. 1993;328:750–755. doi: 10.1056/NEJM199303183281102. DOI: https://doi.org/10.1056/NEJM199303183281102
- Klein AL, Grimm RA, Murray RD, Apperson-Hansen C, Asinger RW, Black IW, et al. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N. Engl. J. Med. 2001;344(19):1411–1420. doi: 10.1056/NEJM200105103441901. DOI: https://doi.org/10.1056/NEJM200105103441901
- Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ. Obesity and thrombosis. Eur J Vasc Endovasc Surg. 2007;33:223–233. doi: 10.1016/j.ejvs.2006.10.006. DOI: https://doi.org/10.1016/j.ejvs.2006.10.006
- Sola E, Vaya A, Corella D, Santaolaria ML, Espana F, Estelles A, et al. Erythrocyte hyperaggregation in obesity: determining factors and weight loss influence. Obesity. 2007;15:2128–2134. doi: 10.1038/oby.2007.253 DOI: https://doi.org/10.1038/oby.2007.253
- Kim J, Bak M, Park SJ, Jeong DS, Chung S, Kim D, et al. Clinical Implication of Left Atrial Appendage Emptying Velocity in Thoracoscopic Ablation of Atrial Fibrillation. Circ J. 2023 Nov 24;87(12):1742-1749. doi: 10.1253/circj.CJ-23-0040. Epub 2023 Jun 27. PMID: 37380436. DOI: https://doi.org/10.1253/circj.CJ-23-0040
- Costantini H, Ono T, Shogaki N, Tanaka T, Lyu W, Son B-K, et al. The Impact of Financial Pressure on the Association between Employment and Depressive Symptoms for Community-Dwelling Older Adults. Journal of Ageing and Longevity. 2024; 4(2):41-50. https://doi.org/10.3390/jal4020004 DOI: https://doi.org/10.3390/jal4020004
License
© 2025 The Author(s). Published by Journal of Health and Aging.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
