An echocardiogram is an ultrasound-based assessment of the heart. It is painless, harmless, readily available in most hospitals and can give a large amount of very useful information about the structure and function of the heart. As atrial fibrillation can be caused by a structural problem with the heart such as heart valve disease or heart muscle weakness, the echo can help to elucidate the underlying cause of the AF. Secondly, the echo can help assess the size of the atria. If the atria look very enlarged then it makes it more unlikely that the heart can be restored to a normal rhythm.
Thirdly, one important risk factor for strokes in patients with AF is the presence of heart failure. The echo can easily identify if the heart is weak and therefore help with risk assessment. Fourthly, sometimes when the heart rate is excessively fast due to AF and not adequately controlled, the heart itself can start weakening. This is called tachycardia-induced cardiomyopathy.
The echo can identify tachycardia-induced cardiomyopathy and therefore guide appropriate treatment. The good news is that with appropriate rate control treatment, a tachycardia-induced cardiomyopathy can easily be reversed. Finally, some heart rhythm control medications such as Flecainide should not be used in patients with structural heart disease. A normal echocardiogram is reassuring with this regard and allows such medications to be used.