Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation: a multicenter propensity-matched analysis.
BACKGROUND
Whether routine transesophageal echocardiography (TEE) in addition to multidetector computed tomography (MDCT) has incremental value in preventing periprocedural stroke before atrial fibrillation (AF) ablation is unclear.


OBJECTIVE
The purpose of this study was to evaluate whether screening with MDCT is sufficient for preventing periprocedural stroke.


METHODS
From 4 tertiary centers, we enrolled 1147 patients (902 males, age 57 ± 11 years) with optimal anticoagulation and preserved left ventricular ejection function who had undergone MDCT and routine TEE (group 1, n = 678) or selective TEE (group 2, n = 469) as screening tests before AF ablation. Based on a propensity score analysis, 2 groups with 412 matched pairs were created.


RESULTS
Patient baseline characteristics were comparable between the matched groups. In group 1 (n = 412), thrombi were detected in 4 patients (1.0%) on TEE, and ablation was not performed. These patients also showed thrombi (n = 3) or blood stasis (n = 1) on MDCT. For thrombi detection, MDCT had sensitivity and negative predictive value of 100%. In group 2 (n = 412), thrombi were detected in 7 patients (1.7%) on MDCT. Of these patients , 2 (0.5%) also showed thrombi on TEE. Periprocedural stroke incidence did not differ between the groups (0.2% each, P = 1.0).


CONCLUSIONS
The incidence of periprocedural stroke was low and did not differ significantly between the group assigned to routine TEE vs selective TEE screening in AF patients undergoing anticoagulation therapy if the patients had conditions associated with low thrombus risk. Thus, preprocedural TEE may not be necessary before AF ablation in patients who have undergone preprocedural cardiac MDCT that shows no evidence of left atrial appendage thrombus.
Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Sung-Jin
SJ
Hong
Division of Cardiology, Gangnam Severance Hospital, Seoul, Korea.
Jong-Yun
JY
Kim
Kyung Hee University College of Medicine, Seoul, Korea.
Jin-Bae
JB
Kim
Bundang CHA Medical Center, CHA University, Seoul, Korea.
Jung-Hoon
JH
Sung
Biostatistics Collaboration Unit, Yonsei University Medical College, Seoul, Korea.
Dong
D
Wook Kim
Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Jae-Sun
JS
Uhm
Department of Radiology, Yonsei University Medical College, Seoul, Korea.
Hye-Jeong
HJ
Lee
Department of Radiology, Yonsei University Medical College, Seoul, Korea.
Young
Y
Jin Kim
Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Hui-Nam
HN
Pak
Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea.
Moon-Hyoung
MH
Lee
Cardiology Division, Department of Internal Medicine, Yonsei University Medical College, Seoul, Korea. Electronic address: cby6908@yuhs.ac.
Boyoung
B
Joung
D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D057234:Preoperative Period; D057216:Propensity Score; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013318:Stroke Volume; D016277:Ventricular Function, Left
Atrial fibrillation; Computed tomography; Stroke; Transesophageal echocardiography