Hong, Sung-Jin; Kim, Jong-Yun; Kim, Jin-Bae; Sung, Jung-Hoon; Wook Kim, Dong; Uhm, Jae-Sun; Lee, Hye-Jeong; Jin Kim, Young; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung
Heart rhythm : the official journal of the Heart Rhythm Society
2014May ; 11 ( 5 ) :763-70.
PMID : 24469219
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Hong, Sung-Jin - Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Kim, Jong-Yun - Division of Cardiology, Gangnam Severance Hospital, Seoul, Korea.
Kim, Jin-Bae - Kyung Hee University College of Medicine, Seoul, Korea.
Sung, Jung-Hoon - Bundang CHA Medical Center, CHA University, Seoul, Korea.
Wook Kim, Dong - Biostatistics Collaboration Unit, Yonsei University Medical College, Seoul, Korea.
Uhm, Jae-Sun - Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Lee, Hye-Jeong - Department of Radiology, Yonsei University Medical College, Seoul, Korea.
Jin Kim, Young - Department of Radiology, Yonsei University Medical College, Seoul, Korea.
Pak, Hui-Nam - Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Lee, Moon-Hyoung - Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Joung, Boyoung - Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea. Electronic address cby6908@yuhs.ac.
ABSTRACT
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. CI - Copyright ??2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
keyword
Atrial fibrillation; Computed tomography; Stroke; Transesophageal echocardiography
MESH
Atrial Fibrillation/complications/*radiography/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/etiology/*prevention & control, Stroke Volume, Ventricular Function, Left
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