Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation: A multicenter propensity-matched analysis

Sung Jin Hong, Jong Yun Kim, Jin Bae Kim, Jung Hoon Sung, Dong Wook Kim, Jae Sun Uhm, Hye Jeong Lee, Youngjin Kim, huinam pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 languageEnglish
Pages (from-to)763-770
Number of pages8
JournalHeart Rhythm
Volume11
Issue number5
DOIs
Publication statusPublished - 2014 Jan 1

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Multidetector Computed Tomography
Transesophageal Echocardiography
Atrial Fibrillation
Stroke
Thrombosis
Atrial Appendage
Propensity Score
Incidence
Left Ventricular Function
Research Design

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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. / Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation : A multicenter propensity-matched analysis. In: Heart Rhythm. 2014 ; Vol. 11, No. 5. pp. 763-770.
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title = "Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation: A multicenter propensity-matched analysis",
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.",
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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 journalArticle

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

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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.

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