Omitting transesophageal echocardiography before catheter ablation of atrial fibrillation
One devastating but potentially avoidable complication of catheter ablation of atrial fibrillation is thromboembolic stroke. It could be caused by mobilization of the left atrial appendage thrombus. Transesophageal echocardiography is the gold standard for preprocedural screening. However, concerns have been raised regarding the necessity of performing TEE before every PVI. We aimed to evaluate the safety of an individualised risk-based approach to transesophageal echocardiography with respect to thromboembolic cerebrovascular events in patients undergoing catheter ablation for atrial fibrillation. We performed a retrospective clinical study. A total of 1155 patients undergone catheter ablation for atrial fibrillation were enrolled. Prior to the procedure, patients were scheduled for transesophageal echocardiography only if they had a history of thromboembolic stroke, left atrial appendage thrombus, or inappropriate anticoagulation regimen in the previous three to four weeks. The incidence of periprocedural cerebrovascular thromboembolic events was assessed. A total of 4 out of 1153 (0.35%) patients, who underwent the ablation procedure, experienced thromboembolic cerebrovascular events. The rate of cerebrovascular thromboembolic events in our study doesn't exceed that reported in most multicentre trials. In all four patients with cerebrovascular thromboembolic events, imaging after the event showed the absence of thrombus in the left atrial appendage. The low event rates limited statistical analysis of possible risk factors for cerebrovascular thromboembolic events. In summary, an individualized selective approach to transesophageal echocardiography before catheter ablation of atrial fibrillation proved to be safe. In patients with uninterrupted oral anticoagulation and no history of thromboembolic events, transesophageal echocardiography before the catheter ablation could be omitted.
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