Abstract
Background Whether routine transesophageal echocardiography (TEE) in addition to multidetector computed tomography (MDCT) has incremental value in preventing periprocedural stroke before atrial fibrillation (AF) ablation is unclear. Objective The purpose of this study was to evaluate whether screening with MDCT is sufficient for preventing periprocedural stroke. Methods From 4 tertiary centers, we enrolled 1147 patients (902 males, age 57 ± 11 years) with optimal anticoagulation and preserved left ventricular ejection function who had undergone MDCT and routine TEE (group 1, n = 678) or selective TEE (group 2, n = 469) as screening tests before AF ablation. Based on a propensity score analysis, 2 groups with 412 matched pairs were created. Results Patient baseline characteristics were comparable between the matched groups. In group 1 (n = 412), thrombi were detected in 4 patients (1.0%) on TEE, and ablation was not performed. These patients also showed thrombi (n = 3) or blood stasis (n = 1) on MDCT. For thrombi detection, MDCT had sensitivity and negative predictive value of 100%. In group 2 (n = 412), thrombi were detected in 7 patients (1.7%) on MDCT. Of these patients, 2 (0.5%) also showed thrombi on TEE. Periprocedural stroke incidence did not differ between the groups (0.2% each, P = 1.0). Conclusion The incidence of periprocedural stroke was low and did not differ significantly between the group assigned to routine TEE vs selective TEE screening in AF patients undergoing anticoagulation therapy if the patients had conditions associated with low thrombus risk. Thus, preprocedural TEE may not be necessary before AF ablation in patients who have undergone preprocedural cardiac MDCT that shows no evidence of left atrial appendage thrombus.
| Original language | English |
|---|---|
| Pages (from-to) | 763-770 |
| Number of pages | 8 |
| Journal | Heart Rhythm |
| Volume | 11 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 2014 Jan 1 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
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Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation : A multicenter propensity-matched analysis. / Hong, Sung Jin; Kim, Jong Yun; Kim, Jin Bae; Sung, Jung Hoon; Wook Kim, Dong; Uhm, Jae Sun; Lee, Hye Jeong; Kim, Youngjin; pak, huinam; Lee, Moon Hyoung; Joung, Boyoung.
In: Heart Rhythm, Vol. 11, No. 5, 01.01.2014, p. 763-770.Research output: Contribution to journal › Article
TY - JOUR
T1 - Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation
T2 - A multicenter propensity-matched analysis
AU - Hong, Sung Jin
AU - Kim, Jong Yun
AU - Kim, Jin Bae
AU - Sung, Jung Hoon
AU - Wook Kim, Dong
AU - Uhm, Jae Sun
AU - Lee, Hye Jeong
AU - Kim, Youngjin
AU - pak, huinam
AU - Lee, Moon Hyoung
AU - Joung, Boyoung
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Background Whether routine transesophageal echocardiography (TEE) in addition to multidetector computed tomography (MDCT) has incremental value in preventing periprocedural stroke before atrial fibrillation (AF) ablation is unclear. Objective The purpose of this study was to evaluate whether screening with MDCT is sufficient for preventing periprocedural stroke. Methods From 4 tertiary centers, we enrolled 1147 patients (902 males, age 57 ± 11 years) with optimal anticoagulation and preserved left ventricular ejection function who had undergone MDCT and routine TEE (group 1, n = 678) or selective TEE (group 2, n = 469) as screening tests before AF ablation. Based on a propensity score analysis, 2 groups with 412 matched pairs were created. Results Patient baseline characteristics were comparable between the matched groups. In group 1 (n = 412), thrombi were detected in 4 patients (1.0%) on TEE, and ablation was not performed. These patients also showed thrombi (n = 3) or blood stasis (n = 1) on MDCT. For thrombi detection, MDCT had sensitivity and negative predictive value of 100%. In group 2 (n = 412), thrombi were detected in 7 patients (1.7%) on MDCT. Of these patients, 2 (0.5%) also showed thrombi on TEE. Periprocedural stroke incidence did not differ between the groups (0.2% each, P = 1.0). Conclusion The incidence of periprocedural stroke was low and did not differ significantly between the group assigned to routine TEE vs selective TEE screening in AF patients undergoing anticoagulation therapy if the patients had conditions associated with low thrombus risk. Thus, preprocedural TEE may not be necessary before AF ablation in patients who have undergone preprocedural cardiac MDCT that shows no evidence of left atrial appendage thrombus.
AB - Background Whether routine transesophageal echocardiography (TEE) in addition to multidetector computed tomography (MDCT) has incremental value in preventing periprocedural stroke before atrial fibrillation (AF) ablation is unclear. Objective The purpose of this study was to evaluate whether screening with MDCT is sufficient for preventing periprocedural stroke. Methods From 4 tertiary centers, we enrolled 1147 patients (902 males, age 57 ± 11 years) with optimal anticoagulation and preserved left ventricular ejection function who had undergone MDCT and routine TEE (group 1, n = 678) or selective TEE (group 2, n = 469) as screening tests before AF ablation. Based on a propensity score analysis, 2 groups with 412 matched pairs were created. Results Patient baseline characteristics were comparable between the matched groups. In group 1 (n = 412), thrombi were detected in 4 patients (1.0%) on TEE, and ablation was not performed. These patients also showed thrombi (n = 3) or blood stasis (n = 1) on MDCT. For thrombi detection, MDCT had sensitivity and negative predictive value of 100%. In group 2 (n = 412), thrombi were detected in 7 patients (1.7%) on MDCT. Of these patients, 2 (0.5%) also showed thrombi on TEE. Periprocedural stroke incidence did not differ between the groups (0.2% each, P = 1.0). Conclusion The incidence of periprocedural stroke was low and did not differ significantly between the group assigned to routine TEE vs selective TEE screening in AF patients undergoing anticoagulation therapy if the patients had conditions associated with low thrombus risk. Thus, preprocedural TEE may not be necessary before AF ablation in patients who have undergone preprocedural cardiac MDCT that shows no evidence of left atrial appendage thrombus.
UR - http://www.scopus.com/inward/record.url?scp=84899423504&partnerID=8YFLogxK
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U2 - 10.1016/j.hrthm.2014.01.026
DO - 10.1016/j.hrthm.2014.01.026
M3 - Article
C2 - 24469219
AN - SCOPUS:84899423504
VL - 11
SP - 763
EP - 770
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 5
ER -