Pre-procedural transoesophageal echocardiography detected left atrial thrombi in only 1.47% of patients undergoing ablation, with zero cases in paroxysmal AF patients without LA dilation.
Observational (n=408)
Does routine pre-procedural TEE identify LA thrombus in all patients with atrial fibrillation undergoing CPVA?
Routine TEE prior to CPVA may not be necessary in patients with paroxysmal AF who lack LA dilation or structural heart disease, given the very low incidence of LA thrombus in this subgroup.
AIMS: Transoesophageal echocardiography (TEE) is recommended prior to circumferential pulmonary vein ablation (CPVA) in patients with atrial fibrillation (AF) to identify left atrial (LA) or left atrial appendage (LAA) wall thrombi. It is not clear whether all patients undergoing CPVA should receive pre-procedural TEE. We wanted to assess the incidence of LA thrombus in these patients and to identify factors associated with its presence. METHODS AND RESULTS: Consecutive patients referred for CPVA from 2004 to 2009 underwent TEE within 48 h prior to the procedure. Of 408 patients included in the study, 6 patients (1.47%) had LA thrombi, persistent AF, and LA dilation. Compared with patients without thrombus, these six patients had larger LA diameter (P = 0.0001) and more frequently were women (P = 0.002), had persistent AF (P = 0.04), and had underlying structural cardiac disease (P = 0.014). The likelihood of presenting LA thrombus increased with the number of these four risk factors present (P < 0.001). None of the patients with paroxysmal AF and without LA dilation had LA thrombus. A cut-off value of 48.5 mm LA diameter yielded 83% sensitivity, 92% specificity, and a 10.1 likelihood ratio to predict LA thrombus appearance. CONCLUSION: The incidence of LA thrombus prior to CPVA is low. Persistent AF, female sex, structural cardiopathy, and LA dilation were associated with the presence of LA thrombus. Our data suggest that the use of TEE prior to CPVA to detect LA thrombi might not be needed in patients with paroxysmal AF and no LA dilation or structural cardiopathy.
Calvo et al. (Fri,) conducted a observational in Atrial fibrillation (n=408). Transoesophageal echocardiography (TEE) was evaluated on Incidence of left atrial thrombus. Pre-procedural transoesophageal echocardiography detected left atrial thrombi in only 1.47% of patients undergoing ablation, with zero cases in paroxysmal AF patients without LA dilation.