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. 2024 Nov;67(8):1781-1791.
doi: 10.1007/s10840-024-01825-8. Epub 2024 May 18.

Omitting transesophageal echocardiography before catheter ablation of atrial fibrillation

Vera Maslova  1 , Thomas Demming  1 , Robert Pantlik  2 , Tamas Geczy  2 , Peter Falk  2 , Bjoern Andrew Remppis  2 , Derk Frank  1 , Evgeny Lian  3
Affiliations

Omitting transesophageal echocardiography before catheter ablation of atrial fibrillation

Vera Maslova et al. J Interv Card Electrophysiol. 2024 Nov.

Abstract

Background: Data about necessity of performing transesophageal echocardiography (TOE) prior to every catheter ablation (CA) of atrial fibrillation (AF) is scarce. We aimed to evaluate the safety of an individualized risk-based approach to TOE with respect to thromboembolic cerebrovascular events (CVE) in patients undergoing CA for AF or left atrial tachycardia (AT).

Methods: We performed a retrospective clinical study based on our institutional registry database. Patients undergoing CA for AF or left-sided AT following initial AF ablation at two participating centers were enrolled. Prior to the procedure, patients were scheduled for TOE only if they had a history of thromboembolic stroke, left atrial appendage (LAA) thrombus, or inappropriate anticoagulation regimen in the previous 3 to 4 weeks. The incidence of periprocedural cerebrovascular thromboembolic events was assessed.

Results: We analyzed 1155 patients (median age 70 years, 54.8% male, 48.1% had persistent AF/AT). In 261 patients, a TOE was performed; in 2 patients (0.7%), an LAA thrombus was detected, which led to cancellation of the catheter ablation; in 894 patients, the TOE was omitted. Of the 1153 (0.35%) patients who underwent ablation, 4 (0.35%) experienced a CVE (one TIA and three strokes). The rate of CVE in our study does not exceed that reported in most multicenter trials. The low event rates limited statistical analysis of possible risk factors for CVE. In all 4 patients with CVE, post-CVE imaging showed the absence of LAA thrombus.

Conclusions: An individualized selective approach to TOE before catheter ablation of AF or left AT showed a very low risk of overt intraprocedural thromboembolic events for the population in our study. A further randomized controlled study is needed to determine whether TOE prior to catheter ablation without ICE could be omitted in patients with uninterrupted OAC without previous thromboembolic events or a history of left atrial thrombus.

Keywords: Ablation; Atrial fibrillation; Stroke; Transesophageal echocardiography.

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Conflict of interest statement

Declarations. Ethics approval: Approval of local ethic committee. Consent to participate: Not applicable. Consent for publication: Not applicable. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Periprocedural anticoagulation management
Fig. 2
Fig. 2
Risk-based scheduling to preprocedural TOE
See this image and copyright information in PMC

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