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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
MeSH
Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications ; Atrial Fibrillation/surgery* ; Catheter Ablation* ; Echocardiography, Transesophageal* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Multidetector Computed Tomography ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Preoperative Care/methods* ; Republic of Korea/epidemiology ; Retrospective Studies ; Stroke/diagnosis ; Stroke/etiology ; Stroke/prevention & control* ; Unnecessary Procedures*
Keywords
Anticoagulation ; Atrial fibrillation ; Stroke ; Transesophageal echocardiography
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. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Shim, Jae Min(심재민)
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0001-7549-9430
Lee, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Han, Jae Hyun(한재현)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/88316
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