Key result
A novel standard operating procedure for preprocedural TEE screening reduced performed TEEs by 67% with no significant difference in transitory ischaemic attack (0.32% vs 0.53%; P=0.48).
Why the study?
Preprocedural TEE imposes procedural risks, causes discomfort, and is challenging to implement; the study evaluated whether a novel SOP could reduce preprocedural TEEs without increasing cerebrovascular events.
Does a risk-stratified SOP for TEE screening reduce preprocedural TEEs without increasing cerebrovascular events in patients undergoing atrial arrhythmia ablation?
Cohort (n=1,874)
No
Does a risk-stratified SOP for TEE screening reduce preprocedural TEEs without increasing cerebrovascular events in patients undergoing atrial arrhythmia ablation?
Absolute Event Rate: 0.32% vs 0.53%
p-value: p=0.48
A risk-stratified SOP safely reduces preprocedural TEEs by 67% before atrial fibrillation ablation without increasing the risk of cerebrovascular events.
SOP may safely exempt low-risk AF ablation patients from TEE; leaves open need for prospective validation before practice change.
AIMS: Preprocedural transoesophageal echocardiography (TEE) screening for left atrial (LA) thrombi is the standard of care in many centres performing atrial fibrillation (AF) ablation. However, TEE imposes procedural risks for patients and is often challenging to implement in daily practice, besides causing patient discomfort. At our centre, a novel standard operating procedure (SOP) was implemented, aiming to identify patients that can be exempt from TEE screening. We aimed to assess whether this screening approach may reduce preprocedural TEEs without imposing patients of higher risks for cerebrovascular events (CVEs). METHODS AND RESULTS: Data of 1874 consecutive patients treated by catheter ablation of LA arrhythmias between 2018 and 2022 were retrospectively analysed. A cohort of 937 patients, where decision to perform TEE screening was based on a new SOP (considering rhythm at admission, CHA2DS2-VASc score, and sufficient anticoagulation), was compared to a matched cohort receiving TEE before every procedure. Number of performed TEEs and incidences of CVEs were compared. Implementation of the new SOP led to a 67% reduction in TEEs performed (old SOP: 933 vs. new SOP: 305). No significant differences between the groups were detected regarding transitory ischaemic attack (old SOP: 5 vs. new SOP: 3; P = 0.48) and stroke (no events). No solid thrombi were detected during TEE screening. CONCLUSION: The number of preprocedural screening TEEs before AF ablation procedures can be safely reduced by applying risk stratification based on rhythm at admission and CHA2DS2-VASc score, if anticoagulation was performed properly.
No takes yet. Share an insight, caveat, or question.
Dittrich et al. (2023) conducted a cohort in Left atrial arrhythmias / Atrial fibrillation (n=1,874). New standard operating procedure for TEE screening vs. Routine TEE before every procedure (old SOP) was evaluated on Transitory ischaemic attack (p=0.48). A novel standard operating procedure for preprocedural TEE screening reduced performed TEEs by 67% with no significant difference in transitory ischaemic attack (0.32% vs 0.53%; P=0.48).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: