Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.
Department of Cardiology, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany.
J Interv Card Electrophysiol. 2024 Nov;67(8):1781-1791. doi: 10.1007/s10840-024-01825-8. Epub 2024 May 18.
Data about necessity of performing transesophageal echocardiography (TOE) prior to every catheter ablation (CA) of atrial fibrillation (AF) is scarce. We aimed to evaluate the safety of an individualized risk-based approach to TOE with respect to thromboembolic cerebrovascular events (CVE) in patients undergoing CA for AF or left atrial tachycardia (AT).
We performed a retrospective clinical study based on our institutional registry database. Patients undergoing CA for AF or left-sided AT following initial AF ablation at two participating centers were enrolled. Prior to the procedure, patients were scheduled for TOE only if they had a history of thromboembolic stroke, left atrial appendage (LAA) thrombus, or inappropriate anticoagulation regimen in the previous 3 to 4 weeks. The incidence of periprocedural cerebrovascular thromboembolic events was assessed.
We analyzed 1155 patients (median age 70 years, 54.8% male, 48.1% had persistent AF/AT). In 261 patients, a TOE was performed; in 2 patients (0.7%), an LAA thrombus was detected, which led to cancellation of the catheter ablation; in 894 patients, the TOE was omitted. Of the 1153 (0.35%) patients who underwent ablation, 4 (0.35%) experienced a CVE (one TIA and three strokes). The rate of CVE in our study does not exceed that reported in most multicenter trials. The low event rates limited statistical analysis of possible risk factors for CVE. In all 4 patients with CVE, post-CVE imaging showed the absence of LAA thrombus.
An individualized selective approach to TOE before catheter ablation of AF or left AT showed a very low risk of overt intraprocedural thromboembolic events for the population in our study. A further randomized controlled study is needed to determine whether TOE prior to catheter ablation without ICE could be omitted in patients with uninterrupted OAC without previous thromboembolic events or a history of left atrial thrombus.
关于在进行房颤（AF）导管消融（CA）前是否必须进行经食管超声心动图（TOE），相关数据较为匮乏。我们旨在评估个体化风险导向型 TOE 策略在因 AF 或左房房速（AT）而接受 CA 的患者中应用的安全性，尤其是针对血栓栓塞性脑血管事件（CVE）的安全性。
我们进行了一项基于机构注册数据库的回顾性临床研究。纳入了在两个参与中心接受初始 AF 消融后因 AF 或左侧 AT 而行 CA 的患者。在进行该操作前，仅当患者在过去 3-4 周内有血栓栓塞性卒中、左心耳（LAA）血栓或不适当的抗凝方案时，才安排 TOE。评估围手术期脑血管血栓栓塞事件的发生率。
我们分析了 1155 例患者（中位年龄 70 岁，54.8%为男性，48.1%为持续性 AF/AT）。261 例行 TOE，2 例（0.7%）检测到 LAA 血栓，导致 CA 取消；894 例患者未行 TOE。1153 例行消融术的患者中（0.35%），有 4 例（0.35%）发生 CVE（1 例 TIA 和 3 例卒中）。本研究中的 CVE 发生率并未超过大多数多中心试验报道的发生率。低事件率限制了对 CVE 可能危险因素的统计分析。在所有 4 例发生 CVE 的患者中，CVE 后影像学检查均未发现 LAA 血栓。
AF 或左 AT 导管消融前进行个体化选择性 TOE 策略显示，对于本研究人群，术中显性血栓栓塞事件的风险非常低。需要进一步进行随机对照研究，以确定对于无既往血栓栓塞事件或左心房血栓史、持续接受 OAC 治疗且无中断的患者，在行 CA 前若无 ICE 是否可以省略 TOE。
