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Transoesophageal Echocardiogram

What is a TOE?

A TOE is an ultrasound scan of the heart performed from inside the oesophagus, the food pipe that runs from your mouth to your stomach. A thin, flexible probe is gently passed into the oesophagus via the back of the throat. Because the oesophagus sits directly behind the heart, this gives a remarkably detailed image of the heart's chambers, valves, and surrounding structures.

You will be given a throat spray to numb the area and, in most cases, a light sedative to keep you comfortable. Most patients find the procedure much easier than they expected.

A male physician in blue scrubs and a grey blazer sits at a consultation desk in a clinical room, smiling broadly while writing notes during a patient consultation.

How is a TOE different from a standard heart scan?

A standard echocardiogram (echo) is performed by placing an ultrasound probe on the outside of your chest. It is a very useful test, but the images can sometimes be limited by the ribs, lungs, or body tissue between the probe and your heart.

A TOE bypasses all of that. Because the probe is inside the oesophagus — just centimetres from the back of the heart — the images are far sharper and more detailed. This makes it the gold standard for visualising certain structures, particularly the left atrial appendage: a small pouch in the upper left chamber of the heart where blood clots can form in AF.

Why might you need a TOE?

There are several reasons Dr. Kaba might recommend a TOE. The most common include:

  • Checking for a blood clot before cardioversion - if you have AF and are due to have a cardioversion, a TOE confirms there is no clot in the heart before proceeding. This significantly reduces the risk of stroke.
  • Detailed valve assessment - a TOE gives an exceptional view of the heart valves, particularly the mitral valve, and is often needed when planning certain procedures.
  • Investigating structural heart problems - if a standard echo has raised a question that needs a clearer answer, a TOE provides it.
  • Guiding other procedures - TOE is sometimes used in real time during certain interventional procedures to guide catheter placement.

How to prepare

Preparing for a TOE is straightforward. Please follow these instructions carefully:

  • Fasting: You must not eat or drink anything (except small sips of water for essential medications) for at least six hours before your appointment. This is essential for your safety
  • Medications: Most medications can be taken as normal with a small sip of water. You will receive specific guidance if any need to be paused, particularly blood thinners.
  • On the day: Please wear comfortable, loose clothing. Remove any dentures before the procedure begins.
  • Escort: You will need someone to take you home. Because of the sedation, you must not drive for 24 hours after your appointment.

What happens during the procedure

When you arrive, a nurse will check your observations, attach heart monitoring leads, and place a small cannula in your arm for the sedative. Dr. Kaba will speak with you before the scan begins.

A local anaesthetic spray is applied to the back of your throat to numb the area. Once the sedative has taken effect, the probe - about the width of a finger - is gently passed through your mouth and into your oesophagus. You will be asked to swallow as it passes, which helps it move smoothly.

Once in position, a series of detailed images is taken from different angles. This usually takes around 15 to 30 minutes. Throughout the procedure, a nurse monitors your heart rate, blood pressure, and oxygen levels. Most patients are not aware of the procedure once the sedative has taken effect.

A diverse team of eight healthcare professionals pose together in a hospital corridor near a Cardiac Ward nurses' station. Staff wear a variety of scrubs and clinical uniforms.

What the results mean

The most common reason for a TOE before cardioversion is to check for a blood clot in the left atrial appendage. If no clot is found, cardioversion can go ahead safely. If a clot is found, the procedure will be delayed and your blood thinners adjusted before rescanning.

For other reasons - such as valve assessment or structural questions - Dr. Kaba will explain clearly what he has found, using plain language without unnecessary jargon. You will always leave knowing what the results mean for your care.

Recovery and aftercare

A TOE is a day-case procedure. You will rest for approximately 30 to 60 minutes while the sedative wears off. Once you are fully alert and able to swallow comfortably, you will be able to go home.

  • Eating and drinking: Your throat may feel numb for an hour or two. Wait until the numbness has fully worn off before eating or drinking, to avoid the risk of choking.
  • Driving: You must not drive for 24 hours after receiving sedation.
  • Work: Most people feel perfectly well by the following day.
  • Sore throat: A mild sore throat is common and usually resolves within 24 to 48 hours.

Risks and Complications

A TOE is a very safe procedure. Serious complications are rare. The main risks are:

  • Sore throat: the most common side effect, usually mild and short-lived.
  • Reactions to sedation: mild nausea or drowsiness after the procedure is possible but uncommon.
  • Injury to the oesophagus: very rare. In experienced hands, the risk of significant oesophageal injury is less than 1 in 10,000.
  • Aspiration: breathing in small amounts of fluid is a theoretical risk, which is why fasting beforehand is so important.

Dr. Kaba will discuss all of these risks with you fully before the procedure begins.

Frequently
asked questions

Most patients find a TOE much more comfortable than they expected. The throat spray numbs the area effectively, and the sedation means most people have little or no memory of the procedure.

You will receive a sedative that makes you drowsy and relaxed. You may drift in and out of awareness, but you will not be under a general anaesthetic. Most patients remember very little of the procedure.

No. Because of the sedation, you must not drive for 24 hours. Please arrange for someone to accompany you and take you home.

In most cases, Dr. Kaba will be able to discuss the key findings with you on the same day before you leave. A formal written report will follow shortly after.

If a clot is found in the heart, your cardioversion will not go ahead that day. Dr. Kaba will adjust your blood thinners and arrange to rescan after a further period — usually four to six weeks — once the clot has resolved and it is safe to proceed.

The scan typically takes between 15 and 30 minutes. Including preparation and recovery, you should plan to be with us for approximately two to three hours in total.

Not necessarily. If you have been taking blood thinners consistently for at least four weeks, it is often possible to proceed with cardioversion without a TOE. Dr. Kaba will advise you on which approach is most appropriate for your individual situation.

Why Dr Kaba

Why choose Dr Kaba for Transoesophageal Echocardiogram?

Dr. Kaba performs TOEs as part of a complete, joined-up care pathway. So the scan, the result, and the next steps are all handled by the same doctor who knows your full clinical history.

  • Dr. Kaba has spent over 25 years caring for patients with heart rhythm disorders. He performs these procedures regularly, so you benefit from a level of skill and familiarity that only comes with high-volume specialist practice.
  • He trained in London and held a visiting professorship at Columbia University in New York. He has performed world-first and UK-first procedures, leads a research team at City St. George's, University of London, and has received awards from the European Society of Cardiology and the Heart Rhythm Society in the USA.
  • Patients come to see Dr. Kaba from across the UK, Europe, the Middle East, and Asia. He speaks several languages and takes the time to make sure you fully understand your condition, your options, and what to expect before, during, and after any procedure.
Portrait of Dr Kaba

What private care means for you

Private care gives you timely access to specialist cardiac expertise, clear communication at each step, and a personalised treatment pathway built around your clinical needs. You receive continuity of consultant-led care from initial assessment through to follow-up.

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