Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH.
Circ Arrhythm Electrophysiol. 2020 Sep;13(9):e008301. doi: 10.1161/CIRCEP.119.008301. Epub 2020 Jul 24.
Many centers continue to routinely perform transesophageal echocardiograms before atrial fibrillation (AF) ablation procedures in patients treated with direct oral anticoagulants (DOACs). One study suggested that the procedures could be done without transesophageal echocardiogram but used intracardiac echocardiography imaging of the appendage from the right ventricular outflow. This study aimed to assess the safety of ablation for AF without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage in DOAC compliant patients.
All patients undergoing AF ablation at the Cleveland Clinic (2011-2018) were enrolled in a prospectively maintained data registry. All consecutive patients presenting with AF or atrial flutter on DOAC were included. Periprocedural thromboembolic complications were assessed.
A total of 900 patients were included. Their median CHADS-VASc score was 2 (interquartile range 1-3). All were on DOACs (333 rivaroxaban, 285 dabigatran, 281 apixaban, and 1 edoxaban). Thromboembolic complications occurred in 4 patients (0.3%): 2 ischemic strokes, 1 transient ischemic attack without residual deficit, and 1 splenic infarct; all with no further complications. Bleeding complications occurred in 5 patients (0.4%): 2 pericardial effusions (1 intraoperative, 1 after 30 days, both drained), 3 groin hematomas (1 of them due to needing heparin for venous thrombosis, none required interventions). No patients required emergent surgeries.
In DOAC compliant patients who present for ablation in AF/atrial flutter, the procedures could be performed without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage; with low risk of complications.
许多中心在接受直接口服抗凝剂（DOAC）治疗的患者进行房颤（AF）消融术前，仍常规进行经食管超声心动图检查。一项研究表明，这些程序可以在不进行经食管超声心动图检查的情况下进行，但需要使用右心室流出道心腔内超声心动图对心耳进行成像。本研究旨在评估在符合 DOAC 条件的患者中，不进行经食管超声心动图筛查或心腔内超声心动图对心耳成像的情况下，进行 AF 消融的安全性。
克利夫兰诊所（2011-2018 年）所有接受 AF 消融的患者均纳入前瞻性维护的数据登记处。所有因 DOAC 而出现 AF 或心房扑动的连续患者均被纳入。评估围手术期血栓栓塞并发症。
共纳入 900 例患者。其 CHADS-VASc 评分中位数为 2（四分位距 1-3）。所有患者均服用 DOAC（333 例利伐沙班、285 例达比加群、281 例阿哌沙班和 1 例依度沙班）。4 例（0.3%）患者发生血栓栓塞并发症：2 例缺血性中风、1 例无残留缺损的短暂性脑缺血发作和 1 例脾梗死；均无进一步并发症。5 例（0.4%）患者发生出血并发症：2 例心包积液（1 例术中，1 例 30 天后，均引流），3 例腹股沟血肿（1 例因静脉血栓形成需要肝素，均无需干预）。无患者需要紧急手术。
在因 AF/心房扑动而接受消融术的符合 DOAC 条件的患者中，可不进行经食管超声心动图筛查或心腔内超声心动图对心耳成像，且并发症风险较低。
