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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

 Sung-Jin Hong  ;  Jong-Yun Kim  ;  Jin-Bae Kim  ;  Jung-Hoon Sung  ;  Dong Wook Kim  ;  Jae-Sun Uhm  ;  Hye-Jeong Lee  ;  Young Jin Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
 HEART RHYTHM, Vol.11(5) : 763-770, 2014 
Journal Title
Issue Date
Atrial Fibrillation/complications ; Atrial Fibrillation/diagnostic imaging* ; Atrial Fibrillation/surgery ; Catheter Ablation ; Echocardiography, Transesophageal ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Multidetector Computed Tomography/methods* ; Preoperative Period ; Propensity Score ; Reproducibility of Results ; Republic of Korea/epidemiology ; Retrospective Studies ; Stroke/epidemiology ; Stroke/etiology ; Stroke/prevention & control* ; Stroke Volume ; Ventricular Function, Left
Atrial fibrillation ; Computed tomography ; Stroke ; Transesophageal echocardiography
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Dong Wook(김동욱)
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
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, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
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