title: Transesophageal echocardiography for thrombus screening prior to left atrial catheter ablation.
abstract: BACKGROUND
  Transesophageal echocardiography (TEE) is useful for detecting left atrial (LA) thrombus prior to percutaneous LA catheter ablation in patients with atrial fibrillation (AF). This study was designed to evaluate clinical predictors of LA thrombus and determine indications for TEE screening prior to LA ablation.
  
  
  RESULTS
  The study consisted of 446 patients with drug-resistant AF who were scheduled to undergo initial LA ablation (age 59+/-11 years, 312 males, 136 persistent AF). TEE was performed in all cases within 24 h before ablation. We assessed clinical parameters including CHADS(2) score and echocardiographic parameters. LA thrombus was detected in 13 cases (2.9%) prior to LA ablation (67+/-8 years, 10 males, 12 persistent AF). In multiple logistic regression analysis, advanced age (odds ratio (OR) 1.1, 95% confidence interval (CI) 1.0-1.2; P<0.05), persistent AF (OR 38.1, 95%CI 1.4-988; P<0.05) and structural heart diseases (OR 29.8, 95%CI 2.8-383; P<0.01) were independent positive predictors of LA thrombus prior to ablation, while CHADS(2) score and LA volume were not significant predictors. None of the 136 patients with paroxysmal lone AF whose age was below 60 years had LA thrombus prior to ablation.
  
  
  CONCLUSIONS
  It might be reasonable to omit TEE as a screening examination for LA thrombus prior to LA ablation in younger paroxysmal lone AF patients.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. yamashita-e@cvc.pref.gunma.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Yamashita
authors.forename: Hiroto
authors.initials: H
authors.lastname: Takamatsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Toide
authors.forename: Hiroki
authors.initials: H
authors.lastname: Okaniwa
authors.forename: Naoki
authors.initials: N
authors.lastname: Takemura
authors.forename: Takehito
authors.initials: T
authors.lastname: Sasaki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Miki
authors.forename: Etsuko
authors.initials: E
authors.lastname: Fuke
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hayashi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Koki
authors.initials: K
authors.lastname: Nakamura
authors.forename: Rie
authors.initials: R
authors.lastname: Fukazawa
authors.forename: Chizuru
authors.initials: C
authors.lastname: Sato
authors.forename: Koji
authors.initials: K
authors.lastname: Goto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kaseno
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshizaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging*