What question did this study set out to answer?

To evaluate clinical predictors of left atrial (LA) thrombus and determine indications for routine transesophageal echocardiography (TEE) screening prior to LA catheter ablation in atrial fibrillation (AF).

January 1, 2010Circulation JournalOpen Access

Transesophageal Echocardiography for Thrombus Screening Prior to Left Atrial Catheter Ablation

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Why the study?

What are the clinical predictors of left atrial thrombus detected by TEE prior to left atrial catheter ablation in patients with atrial fibrillation?

Key Points

To evaluate clinical predictors of left atrial (LA) thrombus and determine indications for routine transesophageal echocardiography (TEE) screening prior to LA catheter ablation in atrial fibrillation (AF).
Included 446 patients with drug-resistant AF scheduled for initial LA ablation (mean age 59±11 years, 312 males, 136 persistent AF).
Performed TEE within 24 hours before ablation in all patients to screen for LA thrombus and evaluated clinical parameters, including CHADS2 score and echocardiographic measurements.
LA thrombus was identified prior to ablation in 2.9% of patients (13/446 cases).
Independent predictors of LA thrombus were advanced age (OR 1.1, 95% CI 1.0–1.2, P<0.05), persistent AF (OR 38.1, 95% CI 1.4–988, P<0.05), and structural heart disease (OR 29.8, 95% CI 2.8–383, P<0.01), whereas CHADS2 score and LA volume were not predictive.
None of the 136 patients younger than 60 years with paroxysmal lone AF had detectable LA thrombus.

Structured PICO

What are the clinical predictors of left atrial thrombus detected by TEE prior to left atrial catheter ablation in patients with atrial fibrillation?

Population

446 patients with drug-resistant atrial fibrillation scheduled to undergo initial left atrial catheter ablation, mean age 59+/-11 years, 312 males, 136 with persistent AF.

Intervention

Transesophageal echocardiography (TEE) screening within 24 hours before ablation

Outcome

Detection of left atrial thrombus and identification of clinical predictorssurrogate

TEE screening for left atrial thrombus prior to ablation may be safely omitted in younger patients with paroxysmal lone AF, as advanced age, persistent AF, and structural heart disease are the primary predictors of thrombus.

Discussion

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Implication

Younger paroxysmal lone AF patients had no LA thrombus; hypothesis-generating for selective TEE omission before ablation.

Cite This Study

Yamashita et al. (2010) studied this question.

synapsesocial.com/papers/6a7a9d6402ab7a73dd0300fe https://doi.org/10.1253/circj.cj-09-1002

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Transesophageal Echocardiography for Thrombus Screening Prior to Left Atrial Catheter Ablation

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Transesophageal Echocardiography for Thrombus Screening Prior to Left Atrial Catheter Ablation

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider