Routine preprocedural transesophageal echocardiography might not be necessary for stroke prevention evaluation in AF patients on anticoagulation therapy

Jae Hyun Han, Dong Ho Shin, Hye Jeong Lee, Young Jin Kim, Seung Hyun Lee, Jaemin Shim, Jae Sun Uhm, Jong Youn Kim, Hyuk Jae Chang, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

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Abstract

Background Preprocedural transesophageal echocardiography (TEE) is used to reduce the stroke during atrial fibrillation (AF) ablation. This study evaluated whether routine preprocedural TEE in addition to multidetector computed tomography (MDCT) is necessary to prevent periprocedural stroke in AF ablation. Methods Each patient underwent MDCT and TEE (group 1, n = 247) or MDCT alone (group 2, n = 103) for the initial evaluation before AF ablation. In group 2, TEE was performed only in patients who had left atrial (LA) thrombus or blood stasis in MDCT. Results There was no difference in sex, CHADS2 score, or LA dimension between the two groups. In group 1, a thrombus was detected in 12 (5%) and 6 (2%) patients by the MDCT and TEE, respectively. All (100%) patients, who were revealed to have thrombus in TEE, also had a thrombus in MDCT. In group 2, 3 (3%) patients exhibited LA thrombus in MDCT, among whom thrombus was observed in only one patient (1%) in TEE. AF ablation was not performed in patients with thrombus. While one patient had a periprocedural stroke in group 1, no patient had in group 2 (P = 0.52). Conclusion The overall periprocedural stroke rate was low (0.3%) in AF patients on anticoagulation therapy. The preprocedural MDCT detected all patients with the LA thrombus. In AF patients with low CHADS2 score, optimal anticoagulation and relatively preserved left ventricular ejection fraction, routine preprocedural TEE in addition to the MDCT might not be necessary to decrease the periprocedural stroke rate.

Original languageEnglish
Pages (from-to)1992-1996
Number of pages5
JournalInternational Journal of Cardiology
Volume168
Issue number3
DOIs
Publication statusPublished - 2013 Oct 3

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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