CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC_11(10-11)_426-42710.15836/ccar2016.426Extended AbstractDo all patients undergoing catheter ablation of atrial fibrillation need a pre-procedural transesophageal echocardiography?http://orcid.org/0000-0001-8829-2543KosNikola1http://orcid.org/0000-0002-9707-6946KordićKrešimir1http://orcid.org/0000-0001-6444-2674ManolaŠime1http://orcid.org/0000-0003-2471-4035RadeljićVjekoslav1http://orcid.org/0000-0002-7859-3374BuljNikola1http://orcid.org/0000-0002-4550-4056ZeljkovićIvan1http://orcid.org/0000-0002-0754-7194ZadroInes2http://orcid.org/0000-0003-0684-6333GolubićKarlo1http://orcid.org/0000-0002-7116-2360Delić-BrkljačićDiana1http://orcid.org/0000-0001-9187-7681PavlovićNikola1University Hospital Center “Sestre milosrdnice”, Zagreb, CroatiaGeneral Hospital “Dr. Ivo Pedišić”, Sisak, CroatiaAddress for correspondence: Nikola Pavlović, Klinički bolnički centar Sestre milosrdnice, Vinogradska 29, HR-10000 Zagreb, Croatia. / Phone: +385-1-3787-733 / E-mail: nikolap12@yahoo.com1120161110-1142642715092016101020162016Croatian Cardiac SocietyKeywords: QT prolongationdrug induced arrhythmia
Background: Pulmonary vein isolation (PVI) is a cornerstone of catheter ablation of atrial fibrillation (AF). Current European Heart Rhythm Association Guidelines suggests that all patients undergoing catheter ablation should be anticoagulated for three weeks prior the procedure. (1) All patients with high thromboembolic (TE) risk or in AF should undergo transesophageal echocardiography (TEE) to exclude left atrial thrombus (LAT). Whether patients with low TE risk (estimated with CHA2DS2VASc score) who are in sinus rhythm need TEE routinely remains unclear. The aim of our study was to determine the incidence of LAT in patients undergoing PVI regardless of their risk for TE event.
Patients and Methods: Patients hospitalized at the Departmet of Arrhythmology, University Hospital Center “Sestre milosrdnice” Zagreb from January 2013 to May 2016 undergoing PVI were included in the study. Following routine protocol all patients underwent a pre-procedural TEE to exclude LAT. The TE risk was calculated for each patient using a CHA2DS2-VASc score.
Results: A total of 241 consecutive patients (mean age of 59±11 years, 76% male) were included in the study. The overall incidence of left atrial thrombus was 39/241 (16.18%). As shown in Table 1, 129 patients had CHA2DS2VASc score 0 or 1 (low TE risk) and 18 of them (18/129; 13.95%) had LAT detected (46.15% of all patients with thrombi). 12 patients with LAT in a low TE risk group were adequately anticoagulated while 8 of them were in sinus rhythm. There were 6 low TE risk patients who were adequately anticoagulated and were in sinus rhythm who had LAT (4.5% of low risk patients, 2.4% of all patients). There was no difference in the LAT incidence between the low and high risk groups (13.95% vs 18.75%, p= 0.29).
Incidence of left atrial thrombus in different thromboembolic risk groups.
CHA2DS2-VASc
Number of patients
Number of patients with thrombus
%
0
57
7
12.28
1
72
11
15.28
2
52
8
15.38
3
43
8
18.60
4
7
1
14.2
5
5
3
60
6
0
0
0
7
5
1
20
Total
241
39
16.18
Conclusion: Due to the presence of thrombi in all TE risk groups, even in patients with a low TE risk who were in sinus rhythm and were adequately anticoagulated, TEE (or other imaging modality) could be routinely performed in all patients prior to planned PVI to exclude LAT. The main limitations of the study are relatively small number of patients, lack of standardized follow up of patients with vitamin K antagonists and small proportion of patients on novel anticoagulants. Also, INR data for some patients are lacking which could have influenced the results significantly.
LiteratureEuropean Heart Rhythm AssociationEuropean Association for Cardio-Thoracic SurgeryCammAJKirchhofPLipGYSchottenUSavelievaIErnstS. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). . 2010;31(19):2369–429. 10.1093/eurheartj/ehq27820802247