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

Authors
 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 
Citation
 International Journal of Cardiology, Vol.168(3) : 1992-1996, 2013 
Journal Title
 International Journal of Cardiology 
ISSN
 0167-5273 
Issue Date
2013
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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0167527313000077
DOI
10.1016/j.ijcard.2012.12.096
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김영진(Kim, Young Jin) ORCID logo https://orcid.org/0000-0002-6235-6550
김종윤(Kim, Jong Youn) ORCID logo https://orcid.org/0000-0001-7040-8771
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
신동호(Shin, Dong Ho) ORCID logo https://orcid.org/0000-0002-7874-5542
심재민(Shim, Jae Min)
엄재선(Uhm, Jae Sun) ORCID logo https://orcid.org/0000-0002-1611-8172
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
이승현(Lee, Seung Hyun) ORCID logo https://orcid.org/0000-0001-7549-9430
이혜정(Lee, Hye Jeong) ORCID logo https://orcid.org/0000-0003-4349-9174
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
한재현(Han, Jae Hyun)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/88316
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