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Repeat transesophageal echocardiography may not be necessary for all patients with AF
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Patients with atrial fibrillation who did not have thrombi detected on baseline transesophageal echocardiography were unlikely to have thrombi detected on a repeat study, prompting researchers to suggest that identifying low-risk patients may prevent unnecessary screening.
“There is a lot of literature on looking at patients prior to ablation or cardioversion, especially for their first transesophageal echocardiocardiography to see if they have left atrial thrombus, but there isn’t a lot in the literature looking at patients who have repeat studies after they fail an ablation or have recurrent AF,” David A. Orsinelli, MD, FACC, FASE, of the Ohio State University Wexner Medical Center, told Cardiology Today.
David A. Orsinelli
To further investigate this area, Orsinelli and colleagues conducted a retrospective review of 2,999 patients with AF who had undergone transesophageal echocardiography before cardioversion or radiofrequency catheter ablation.
Of the 263 patients who met inclusion criteria, only two had positive results for thrombus formation on a repeat transesophageal echocardiography (0.8%; 95% CI, 0.21-2.7). Both patients had thrombus identified in the left atrial appendage, and had spontaneous echocardiographic contrast and left atrial enlargement during their baseline studies. INR was 1.9 in one patient and 2.2 in the other, with neither having a therapeutic INR during the 30 days before their repeat examination. CHADS2 scores were 1 and 3, and CHA2DS2-VASc scores were 2 and 6, according to the researchers.
“Both of these patients were fairly high-risk individuals with some markers of risk on their initial study, such as impaired left ventricular function and previous stroke,” Orsinelli said. “They clearly stood out as having a higher risk for developing a thrombus, even though their initial studies were negative.”
Orsinelli noted, however, that the study was limited by its retrospective design and relatively small sample size.
“The ideal way to study this further would be to look at it prospectively in a multicenter study so that we have more patient numbers and can prospectively collect risk factors and data more systematically and then see what the yield is and if we can restratify patients who may not need a repeat study,” he said.
Disclosure: Dr. Orsinelli reports no relevant financial disclosures.
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