Routine preprocedural transesophageal echocardiography might not be necessary for stroke prevention evaluation in AF patients on anticoagulation therapy

Jae Hyun Han, Dong Ho Shin, Hye Jeong Lee, Young Jin Kim, Seung Hyun Lee, Jaemin Shim, Jae Sun Uhm, Jong Youn Kim, Hyuk Jae Chang, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Preprocedural transesophageal echocardiography (TEE) is used to reduce the stroke during atrial fibrillation (AF) ablation. This study evaluated whether routine preprocedural TEE in addition to multidetector computed tomography (MDCT) is necessary to prevent periprocedural stroke in AF ablation. Methods Each patient underwent MDCT and TEE (group 1, n = 247) or MDCT alone (group 2, n = 103) for the initial evaluation before AF ablation. In group 2, TEE was performed only in patients who had left atrial (LA) thrombus or blood stasis in MDCT. Results There was no difference in sex, CHADS2 score, or LA dimension between the two groups. In group 1, a thrombus was detected in 12 (5%) and 6 (2%) patients by the MDCT and TEE, respectively. All (100%) patients, who were revealed to have thrombus in TEE, also had a thrombus in MDCT. In group 2, 3 (3%) patients exhibited LA thrombus in MDCT, among whom thrombus was observed in only one patient (1%) in TEE. AF ablation was not performed in patients with thrombus. While one patient had a periprocedural stroke in group 1, no patient had in group 2 (P = 0.52). Conclusion The overall periprocedural stroke rate was low (0.3%) in AF patients on anticoagulation therapy. The preprocedural MDCT detected all patients with the LA thrombus. In AF patients with low CHADS2 score, optimal anticoagulation and relatively preserved left ventricular ejection fraction, routine preprocedural TEE in addition to the MDCT might not be necessary to decrease the periprocedural stroke rate.

Original languageEnglish
Pages (from-to)1992-1996
Number of pages5
JournalInternational Journal of Cardiology
Volume168
Issue number3
DOIs
Publication statusPublished - 2013 Oct 3
Externally publishedYes

Fingerprint

Transesophageal Echocardiography
Atrial Fibrillation
Multidetector Computed Tomography
Stroke
Thrombosis
Therapeutics
Sex Characteristics
Stroke Volume

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Stroke
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Routine preprocedural transesophageal echocardiography might not be necessary for stroke prevention evaluation in AF patients on anticoagulation therapy. / Han, Jae Hyun; Shin, Dong Ho; Lee, Hye Jeong; Kim, Young Jin; Lee, Seung Hyun; Shim, Jaemin; Uhm, Jae Sun; Kim, Jong Youn; Chang, Hyuk Jae; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung.

In: International Journal of Cardiology, Vol. 168, No. 3, 03.10.2013, p. 1992-1996.

Research output: Contribution to journalArticle

Han, Jae Hyun ; Shin, Dong Ho ; Lee, Hye Jeong ; Kim, Young Jin ; Lee, Seung Hyun ; Shim, Jaemin ; Uhm, Jae Sun ; Kim, Jong Youn ; Chang, Hyuk Jae ; Pak, Hui Nam ; Lee, Moon Hyoung ; Joung, Boyoung. / Routine preprocedural transesophageal echocardiography might not be necessary for stroke prevention evaluation in AF patients on anticoagulation therapy. In: International Journal of Cardiology. 2013 ; Vol. 168, No. 3. pp. 1992-1996.
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title = "Routine preprocedural transesophageal echocardiography might not be necessary for stroke prevention evaluation in AF patients on anticoagulation therapy",
abstract = "Background Preprocedural transesophageal echocardiography (TEE) is used to reduce the stroke during atrial fibrillation (AF) ablation. This study evaluated whether routine preprocedural TEE in addition to multidetector computed tomography (MDCT) is necessary to prevent periprocedural stroke in AF ablation. Methods Each patient underwent MDCT and TEE (group 1, n = 247) or MDCT alone (group 2, n = 103) for the initial evaluation before AF ablation. In group 2, TEE was performed only in patients who had left atrial (LA) thrombus or blood stasis in MDCT. Results There was no difference in sex, CHADS2 score, or LA dimension between the two groups. In group 1, a thrombus was detected in 12 (5{\%}) and 6 (2{\%}) patients by the MDCT and TEE, respectively. All (100{\%}) patients, who were revealed to have thrombus in TEE, also had a thrombus in MDCT. In group 2, 3 (3{\%}) patients exhibited LA thrombus in MDCT, among whom thrombus was observed in only one patient (1{\%}) in TEE. AF ablation was not performed in patients with thrombus. While one patient had a periprocedural stroke in group 1, no patient had in group 2 (P = 0.52). Conclusion The overall periprocedural stroke rate was low (0.3{\%}) in AF patients on anticoagulation therapy. The preprocedural MDCT detected all patients with the LA thrombus. In AF patients with low CHADS2 score, optimal anticoagulation and relatively preserved left ventricular ejection fraction, routine preprocedural TEE in addition to the MDCT might not be necessary to decrease the periprocedural stroke rate.",
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T1 - Routine preprocedural transesophageal echocardiography might not be necessary for stroke prevention evaluation in AF patients on anticoagulation therapy

AU - Han, Jae Hyun

AU - Shin, Dong Ho

AU - Lee, Hye Jeong

AU - Kim, Young Jin

AU - Lee, Seung Hyun

AU - Shim, Jaemin

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Chang, Hyuk Jae

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

PY - 2013/10/3

Y1 - 2013/10/3

N2 - Background Preprocedural transesophageal echocardiography (TEE) is used to reduce the stroke during atrial fibrillation (AF) ablation. This study evaluated whether routine preprocedural TEE in addition to multidetector computed tomography (MDCT) is necessary to prevent periprocedural stroke in AF ablation. Methods Each patient underwent MDCT and TEE (group 1, n = 247) or MDCT alone (group 2, n = 103) for the initial evaluation before AF ablation. In group 2, TEE was performed only in patients who had left atrial (LA) thrombus or blood stasis in MDCT. Results There was no difference in sex, CHADS2 score, or LA dimension between the two groups. In group 1, a thrombus was detected in 12 (5%) and 6 (2%) patients by the MDCT and TEE, respectively. All (100%) patients, who were revealed to have thrombus in TEE, also had a thrombus in MDCT. In group 2, 3 (3%) patients exhibited LA thrombus in MDCT, among whom thrombus was observed in only one patient (1%) in TEE. AF ablation was not performed in patients with thrombus. While one patient had a periprocedural stroke in group 1, no patient had in group 2 (P = 0.52). Conclusion The overall periprocedural stroke rate was low (0.3%) in AF patients on anticoagulation therapy. The preprocedural MDCT detected all patients with the LA thrombus. In AF patients with low CHADS2 score, optimal anticoagulation and relatively preserved left ventricular ejection fraction, routine preprocedural TEE in addition to the MDCT might not be necessary to decrease the periprocedural stroke rate.

AB - Background Preprocedural transesophageal echocardiography (TEE) is used to reduce the stroke during atrial fibrillation (AF) ablation. This study evaluated whether routine preprocedural TEE in addition to multidetector computed tomography (MDCT) is necessary to prevent periprocedural stroke in AF ablation. Methods Each patient underwent MDCT and TEE (group 1, n = 247) or MDCT alone (group 2, n = 103) for the initial evaluation before AF ablation. In group 2, TEE was performed only in patients who had left atrial (LA) thrombus or blood stasis in MDCT. Results There was no difference in sex, CHADS2 score, or LA dimension between the two groups. In group 1, a thrombus was detected in 12 (5%) and 6 (2%) patients by the MDCT and TEE, respectively. All (100%) patients, who were revealed to have thrombus in TEE, also had a thrombus in MDCT. In group 2, 3 (3%) patients exhibited LA thrombus in MDCT, among whom thrombus was observed in only one patient (1%) in TEE. AF ablation was not performed in patients with thrombus. While one patient had a periprocedural stroke in group 1, no patient had in group 2 (P = 0.52). Conclusion The overall periprocedural stroke rate was low (0.3%) in AF patients on anticoagulation therapy. The preprocedural MDCT detected all patients with the LA thrombus. In AF patients with low CHADS2 score, optimal anticoagulation and relatively preserved left ventricular ejection fraction, routine preprocedural TEE in addition to the MDCT might not be necessary to decrease the periprocedural stroke rate.

KW - Anticoagulation

KW - Atrial fibrillation

KW - Stroke

KW - Transesophageal echocardiography

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