Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation

Karuna Chilukuri, Susan A. Mayer, Daniel Scherr, Darshan Dalal, Theodore Abraham, Charles Henrikson, Alan Cheng, Saman Nazarian, Sunil Sinha, David Spragg, Ronald Berger, Hugh Calkins, Joseph E. Marine

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1543-1549
Number of pages7
JournalEuropace
Volume12
Issue number11
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Catheter Ablation
Transesophageal Echocardiography
Atrial Fibrillation
Stroke
Atrial Appendage
Odds Ratio
Coronary Artery Disease
Enoxaparin
Patent Foramen Ovale
Warfarin
Aortic Valve
Aneurysm
Thrombosis
Demography

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Stroke
  • Transoesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation. / Chilukuri, Karuna; Mayer, Susan A.; Scherr, Daniel; Dalal, Darshan; Abraham, Theodore; Henrikson, Charles; Cheng, Alan; Nazarian, Saman; Sinha, Sunil; Spragg, David; Berger, Ronald; Calkins, Hugh; Marine, Joseph E.

In: Europace, Vol. 12, No. 11, 11.2010, p. 1543-1549.

Research output: Contribution to journalArticle

Chilukuri, K, Mayer, SA, Scherr, D, Dalal, D, Abraham, T, Henrikson, C, Cheng, A, Nazarian, S, Sinha, S, Spragg, D, Berger, R, Calkins, H & Marine, JE 2010, 'Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation', Europace, vol. 12, no. 11, pp. 1543-1549. https://doi.org/10.1093/europace/euq295
Chilukuri, Karuna ; Mayer, Susan A. ; Scherr, Daniel ; Dalal, Darshan ; Abraham, Theodore ; Henrikson, Charles ; Cheng, Alan ; Nazarian, Saman ; Sinha, Sunil ; Spragg, David ; Berger, Ronald ; Calkins, Hugh ; Marine, Joseph E. / Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation. In: Europace. 2010 ; Vol. 12, No. 11. pp. 1543-1549.
@article{9a3aba8fa7c24528b48e9f98ee57b413,
title = "Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation",
abstract = "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.",
keywords = "Atrial fibrillation, Catheter ablation, Stroke, Transoesophageal echocardiography",
author = "Karuna Chilukuri and Mayer, {Susan A.} and Daniel Scherr and Darshan Dalal and Theodore Abraham and Charles Henrikson and Alan Cheng and Saman Nazarian and Sunil Sinha and David Spragg and Ronald Berger and Hugh Calkins and Marine, {Joseph E.}",
year = "2010",
month = "11",
doi = "10.1093/europace/euq295",
language = "English (US)",
volume = "12",
pages = "1543--1549",
journal = "Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "11",

}

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

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

UR - http://www.scopus.com/inward/record.url?scp=78049525018&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049525018&partnerID=8YFLogxK

U2 - 10.1093/europace/euq295

DO - 10.1093/europace/euq295

M3 - Article

VL - 12

SP - 1543

EP - 1549

JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

SN - 1099-5129

IS - 11

ER -