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.
Bibliographical noteFunding Information:
Grant support: this study was supported in part by research grants from Yonsei University College of Medicine ( 6-2009-0176 , 6-2010-0059 , 7-2009-0583 , 7-2010-0676 ) and the Basic Science Research Program through the National Research Foundation of Korea , funded by the Ministry of Education, Science and Technology ( 2010-0021993 ).
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine