TY - JOUR
T1 - Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation
AU - Chilukuri, Karuna
AU - Mayer, Susan A.
AU - Scherr, Daniel
AU - Dalal, Darshan
AU - Abraham, Theodore
AU - Henrikson, Charles A.
AU - Cheng, Alan
AU - Nazarian, Saman
AU - Sinha, Sunil
AU - Spragg, David
AU - Berger, Ronald
AU - Calkins, Hugh
AU - Marine, Joseph E.
PY - 2010/11
Y1 - 2010/11
N2 - Aims: 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).Methods and 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 CHADS2 ≥ 2, none emerged as an independent predictor of CVA.Conclusion: 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.
AB - Aims: 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).Methods and 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 CHADS2 ≥ 2, none emerged as an independent predictor of CVA.Conclusion: 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.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Stroke
KW - Transoesophageal echocardiography
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U2 - 10.1093/europace/euq295
DO - 10.1093/europace/euq295
M3 - Article
C2 - 20682553
AN - SCOPUS:78049525018
SN - 1099-5129
VL - 12
SP - 1543
EP - 1549
JO - Europace
JF - Europace
IS - 11
ER -