Omitting transesophageal echocardiography before catheter ablation of atrial fibrillation.

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Interventional Cardiac Electrophysiology Pub Date : 2024-11-01 Epub Date: 2024-05-18 DOI:10.1007/s10840-024-01825-8

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

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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.

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心房颤动导管消融术前省略经食道超声心动图检查。

背景：有关每次房颤导管消融术（CA）前进行经食道超声心动图（TOE）必要性的数据很少。我们的目的是评估基于个体化风险的经食道超声心动图检查方法对因房颤或左房性心动过速（AT）而接受导管消融术的患者血栓栓塞性脑血管事件（CVE）的安全性：我们根据本机构的登记数据库进行了一项回顾性临床研究。在两家参与研究的中心，因房颤或左心房颤动消融术后接受 CA 治疗的患者被纳入研究。手术前，只有在患者有血栓栓塞性中风、左心房阑尾（LAA）血栓或之前 3 至 4 周抗凝方案不当的病史时，才会安排患者接受 TOE。评估了围手术期脑血管血栓栓塞事件的发生率：我们分析了 1155 名患者（中位年龄 70 岁，54.8% 为男性，48.1% 为持续性房颤/AT）。261名患者进行了TOE；2名患者（0.7%）检测到LAA血栓，导致导管消融术取消；894名患者省略了TOE。在接受消融术的 1153 例（0.35%）患者中，有 4 例（0.35%）发生了 CVE（1 例 TIA 和 3 例脑卒中）。我们研究中的 CVE 发生率并未超过大多数多中心试验报告的发生率。较低的事件发生率限制了对 CVE 可能风险因素的统计分析。在所有4例CVE患者中，CVE后造影显示没有LAA血栓：结论：在房颤或左心房颤动导管消融术前对TOE进行个体化选择的方法显示，在我们的研究中，发生明显的术中血栓栓塞事件的风险非常低。我们还需要进一步开展随机对照研究，以确定对于既往无血栓栓塞事件或左心房血栓病史的无间断 OAC 患者，是否可以在不使用 ICE 的导管消融术前省略 TOE。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.