Transesophageal echocardiography for thrombus screening prior to left atrial catheter ablation.
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.
Yamashita
Eiji
E
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. yamashita-e@cvc.pref.gunma.jp
Takamatsu
Hiroto
H
Tada
Hiroshi
H
Toide
Hiroyuki
H
Okaniwa
Hiroki
H
Takemura
Naoki
N
Sasaki
Takehito
T
Miki
Yuko
Y
Fuke
Etsuko
E
Hayashi
Tatsuya
T
Sakamoto
Tamotsu
T
Nakamura
Koki
K
Fukazawa
Rie
R
Sato
Chizuru
C
Goto
Koji
K
Kaseno
Kenichi
K
Kumagai
Koji
K
Naito
Shigeto
S
Hoshizaki
Hiroshi
H
Oshima
Shigeru
S
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*