Ömer Gedikli1, Sanghamitra Mohanty2, Chintan Trivedi3, Carola Gianni3, Qiong Chen4, Domenico Giovanni Della Rocca3, J David Burkhardt3, Javier E Sanchez3, Patrick Hranitzky3, G Joseph Gallinghouse3, Amin Al-Ahmad3, Rodney Horton3, Luigi Di Biase5, Andrea Natale6. 1. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Cardiology, Ondokuz Mayis University Medicine School, Samsun, Turkey. 2. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Dell Medical School, Austin, Texas. 3. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 4. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Henan Provincial People's Hospital, Zhengzhou, China. 5. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York. 6. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Dell Medical School, Austin, Texas; Interventional Electrophysiology, Scripps Clinic, San Diego, California; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California. Electronic address: dr.natale@gmail.com.
Abstract
BACKGROUND: Spontaneous echocardiographic contrast ("smoke") within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. OBJECTIVE: The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. METHODS: A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS2VASc score). RESULTS: In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13%) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6%) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70%) TE complications (6 TIA, 10 stroke) in group 2 (P = .004). In the propensity-matched population, 6 (2.56%) TE complications occurred in group 1 and 1 (0.2%) in group 2 (P = .007). CONCLUSION: In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA2DS2-VASc score.
BACKGROUND: Spontaneous echocardiographic contrast ("smoke") within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. OBJECTIVE: The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. METHODS: A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS2VASc score). RESULTS: In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13%) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6%) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70%) TE complications (6 TIA, 10 stroke) in group 2 (P = .004). In the propensity-matched population, 6 (2.56%) TE complications occurred in group 1 and 1 (0.2%) in group 2 (P = .007). CONCLUSION: In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA2DS2-VASc score.
Authors: Michele Magnocavallo; Giampaolo Vetta; Domenico G Della Rocca; Carola Gianni; Sanghamitra Mohanty; Mohamed Bassiouny; Luca Di Lullo; Armando Del Prete; Donatello Cirone; Carlo Lavalle; Cristina Chimenti; Amin Al-Ahmad; J David Burkhardt; G Joseph Gallinghouse; Javier E Sanchez; Rodney P Horton; Luigi Di Biase; Andrea Natale Journal: Card Electrophysiol Clin Date: 2022-01-22