TY - JOUR
T1 - Can transesophageal echocardiography be safely omitted in patients scheduled for elective ablation of atrial arrhythmias? Data based on the LATTEE registry
AU - Kaufmann, Damian
AU - Królak, Tomasz
AU - Dabrowska-Kugacka, Alicja
AU - Kaplon-Cieslicka, Agnieszka
AU - Gawalko, Monika
AU - Budnik, Monika
AU - Uzieblo-Zyczkowska, Beata
AU - Krzesinski, Pawel
AU - Starzyk, Katarzyna
AU - Wozakowska-Kaplon, Beata
AU - Wójcik, Maciej
AU - Blaszczyk, Robert
AU - Hiczkiewicz, Jaroslaw
AU - Budzianowski, Jan
AU - Mizia-Stec, Katarzyna
AU - Wybraniec, Maciej T
AU - Kosmalska, Katarzyna
AU - Fijalkowski, Marcin
AU - Szymanska, Anna
AU - Dluzniewski, Miroslaw
AU - Haberka, Maciej
AU - Kucio, Michal
AU - Michalski, Blazej
AU - Kupczynska, Karolina
AU - Tomaszuk-Kazberuk, Anna
AU - Wilk-Sledziewska, Katarzyna
AU - Wachnicka-Truty, Renata
AU - Kozinski, Marek
AU - Burchardt, Pawel
AU - Danilowicz-Szymanowicz, Ludmila
PY - 2024
Y1 - 2024
N2 - Background: According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or atrial flutter [AFL]) is not deemed obligatory for optimally anticoagulated patients. However, daily clinical practice significantly differs from the recommendations. Aims: We aimed to identify transthoracic echocardiographic parameters that could be useful in identifying patients without left atrial thrombus (LAT), which makes it possible to avoid unnecessary TEE before scheduled CA. Methods: This is a sub-analysis of a multicenter, prospective, observational study — the LATTEE registry. A total of 1346 patients referred for TEE before scheduled CA of AF/AFL were included. Results: LAT was present in 44 patients (3.3%) and absent in the remaining 1302, who were younger, more likely to have paroxysmal AF, and displayed sinus rhythm during TEE. Additionally, they exhibited a lower incidence of heart failure, diabetes, systemic connective tissue disease, and chronic obstructive pulmonary disease. Furthermore, they had a lower CHA
2DS
2-VASc score and a higher prevalence of direct oral anticoagulants. Echocardiographic parameters, including left ventricular ejection fraction (LVEF) >65%, left atrial diameter (LAD) <40 mm, left atrial area (LAA) <20 cm
2, left atrial volume (LAV) <113 ml, and left atrial volume index (LAVI) <51 ml/m
2, demonstrated 100% sensitivity and 100% negative predictive value for the absence of LAT and were met by 417 patients. Additional echocardiographic indices: LVEF/LAD ≥1.4, LVEF/LAVI ≥1.6, and LVEF/LAA ≥2.7 identified 57 additional patients, bringing the total of predicted LAT-free patients to 474 (35%). Conclusions: Simple echocardiographic parameters could help identify individuals for whom TEE could be safely omitted before elective CA due to atrial arrhythmias.
AB - Background: According to the present guidelines, transesophageal echocardiography (TEE) before scheduled catheter ablation (CA) for atrial arrhythmias (atrial fibrillation [AF] or atrial flutter [AFL]) is not deemed obligatory for optimally anticoagulated patients. However, daily clinical practice significantly differs from the recommendations. Aims: We aimed to identify transthoracic echocardiographic parameters that could be useful in identifying patients without left atrial thrombus (LAT), which makes it possible to avoid unnecessary TEE before scheduled CA. Methods: This is a sub-analysis of a multicenter, prospective, observational study — the LATTEE registry. A total of 1346 patients referred for TEE before scheduled CA of AF/AFL were included. Results: LAT was present in 44 patients (3.3%) and absent in the remaining 1302, who were younger, more likely to have paroxysmal AF, and displayed sinus rhythm during TEE. Additionally, they exhibited a lower incidence of heart failure, diabetes, systemic connective tissue disease, and chronic obstructive pulmonary disease. Furthermore, they had a lower CHA
2DS
2-VASc score and a higher prevalence of direct oral anticoagulants. Echocardiographic parameters, including left ventricular ejection fraction (LVEF) >65%, left atrial diameter (LAD) <40 mm, left atrial area (LAA) <20 cm
2, left atrial volume (LAV) <113 ml, and left atrial volume index (LAVI) <51 ml/m
2, demonstrated 100% sensitivity and 100% negative predictive value for the absence of LAT and were met by 417 patients. Additional echocardiographic indices: LVEF/LAD ≥1.4, LVEF/LAVI ≥1.6, and LVEF/LAA ≥2.7 identified 57 additional patients, bringing the total of predicted LAT-free patients to 474 (35%). Conclusions: Simple echocardiographic parameters could help identify individuals for whom TEE could be safely omitted before elective CA due to atrial arrhythmias.
KW - atrial arrhythmias
KW - atrial fibrillation
KW - catheter ablation
KW - echocardiography
KW - left atrial thrombus
U2 - 10.33963/v.phj.100081
DO - 10.33963/v.phj.100081
M3 - Article
SN - 0022-9032
VL - 82
SP - 492
EP - 499
JO - Kardiologia Polska
JF - Kardiologia Polska
IS - 5
ER -