Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, Canada.
Division of Cardiology, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
Europace. 2019 Jan 1;21(1):48-53. doi: 10.1093/europace/euy129.
There is ongoing controversy about the need for routine transoesophageal echocardiography (TOE) prior to atrial fibrillation (AF) ablation. Recently, the debate was reignited by the publication of a large series of patients showing a prevalence of left atrial appendage thrombus (LAAT) on TOE of 4.4%. We sought to assess the prevalence of LAAT on TOE before AF ablation at our institution.
Consecutive patients scheduled for AF ablation at our institution between January 2009 and December 2016 were included. All patients were on oral anticoagulation for at least 4 weeks prior to TOE. Transoesophageal echocardiographies were performed 3-5 days prior to scheduled AF ablation. Data were collected utilizing a prospective database. In all, 668 patients and 943 AF ablation procedures were included. Mean age was 64 ± 11 years, 72% were male, average CHADS2 score was 1.0 ± 1.0, and 72% of the patients had paroxysmal AF. At the time of ablation, 496 (53%) were on non-vitamin K antagonist oral anticoagulants (NOACs) and 447 (47%) were on Warfarin. There were three cases with LAAT (3/943, 0.3%), all of whom had persistent AF and were on Warfarin. Two patients underwent surgical ablation and the third patient did not undergo ablation.
In our experience, the prevalence of LAAT in patients on anticoagulation therapy undergoing TOE before catheter ablation of AF is 0.3%, which was much lower than recently reported. None of the patients with paroxysmal AF or on NOACs were found to have LAAT. Rather than routine use of TOE prior to AF ablation, a risk-based approach should be considered.
关于在心房颤动（AF）消融之前是否需要常规行经食管超声心动图（TOE）存在持续争议。最近，一项大型患者系列研究的发表重新引发了这一争论，该研究显示 TOE 检测到左心耳血栓（LAAT）的患病率为 4.4%。我们试图评估本机构在 AF 消融前进行 TOE 的 LAAT 患病率。
连续纳入 2009 年 1 月至 2016 年 12 月在我院接受 AF 消融的患者。所有患者在 TOE 前至少接受 4 周的口服抗凝治疗。TOE 在计划的 AF 消融前 3-5 天进行。数据使用前瞻性数据库收集。共纳入 668 例患者和 943 例 AF 消融术。平均年龄为 64±11 岁，72%为男性，平均 CHADS2 评分为 1.0±1.0，72%的患者为阵发性 AF。在消融时，496 例（53%）正在服用非维生素 K 拮抗剂口服抗凝剂（NOACs），447 例（47%）正在服用华法林。有 3 例 LAAT（943 例中的 3 例，0.3%），均为持续性 AF 且正在服用华法林。2 例患者行外科消融，第 3 例患者未行消融。
根据我们的经验，在接受 AF 导管消融前进行 TOE 的抗凝治疗患者中，LAAT 的患病率为 0.3%，远低于最近的报道。未发现阵发性 AF 或服用 NOACs 的患者有 LAAT。AF 消融前不应常规使用 TOE，而应考虑基于风险的方法。
