title: Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation.
abstract: OBJECTIVE
  To assess the utility of transoesophageal echocardiography (TEE) parameters such as spontaneous echo contrast (SEC), left atrial (LA) appendage velocities, and aortic plaque in predicting periprocedural cerebrovascular accidents (CVAs) in patients undergoing catheter ablation of atrial fibrillation (AF).
  
  
  RESULTS
  Five hundred and seventy-nine consecutive patients underwent catheter ablation of AF with pre-procedural TEE, 94% of whom also received pre-procedural warfarin and enoxaparin bridging. Of the 579 patients, 10 patients (cases) who developed periprocedural CVA (1.7%) and 40 randomly selected patients who did not develop CVA (controls) were included (50 study patients, age 58 ± 11 years, 82% male, 54% persistent AF). Periprocedural CVA was defined as a new neurological deficit that occurred anytime between the start of the procedure and 30 days after AF ablation. Demographic, clinical, and TEE variables of cases and controls were compared using standard statistical analyses. Patients with CVA more often had coronary artery disease [odds ratio (OR) 6.0, P = 0.03], previous history of CVA (OR 8.2, P = 0.02), and CHADS(2) score ≥ 2 (OR 5.4, P = 0.03) than patients without CVA. There was no difference in any of the TEE parameters (SEC, LA appendage velocity and area, patent foramen ovale, atrial septal aneurysm, valve abnormality, and aortic plaque). When these TEE parameters were adjusted for coronary artery disease, prior CVA and CHADS(2) ≥ 2, none emerged as an independent predictor of CVA.
  
  
  CONCLUSIONS
  Transoesophageal echocardiographic variables (other than LA thrombus) were not associated with the occurrence of periprocedural CVA in our patients undergoing catheter ablation of AF who generally received pre-procedural anticoagulation. Despite serving as markers of a thrombogenic milieu, the presence of SEC, low LA appendage velocities, and aortic plaque may not increase the risk of periprocedural CVA after AF ablation.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A-1 East, Baltimore, MD 21224, USA.
authors.forename: Karuna
authors.initials: K
authors.lastname: Chilukuri
authors.forename: Susan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherr
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: Theodore
authors.initials: T
authors.lastname: Abraham
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: Sunil
authors.initials: S
authors.lastname: Sinha
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin