Predictive Value of Thromboembolic Risk Scores Before an Atrial Fibrillation Ablation Procedure

Abstract

Not all patients undergoing planned endocardial pulmonary vein isolation need preprocedural TEE. Both scores <2 had an almost maximal negative predictive capability of excluding the presence of a thrombus in the LA/LAA.

Split-Bolus Single-Phase Cardiac Multidetector Computed Tomography for Reliable Detection of Left Atrial Thrombus: Comparison to Transesophageal Echocardiography

“…It still remains questionable if there are certain risk factors that can reliably predict thrombus formation in patients with AF. As previously mentioned, it is common to use the CHADS2 score to validate for estimating the risk of cerebral thromboembolic stroke in patients with AF [5,26]. An LA size of 45 mm evaluated at a 75 % RR interval in MDCT and CHADS2 score ≥ 2 were shown to be independent risk factors for LA/LAA thrombus in our study which is in concordance with the published literature [17,18].…”

“…Spontaneous echo contrast (SEC) in TEE is a common finding and can be found especially in patients with AF due to local circulatory stasis in the LA/LAA region [21,22,26]. It has to be considered that SEC is by definition not identical to thrombus formation in TEE and is therefore not a contraindication for the ablation procedure.…”

Catheter Ablation of Lone Atrial Fibrillation

“…(TEE) performed prior to catheter ablation of AF (mean age of patients was 57 years, 69% with paroxysmal AF) demonstrated the prevalence of LA appendage thrombus in 1% of patients, despite adequate anticoagulation with warfarin during ≥1 month before the procedure [143]. The prevalence of thrombus in LA was significantly higher among patients with persistent AF in comparison to those with paroxysmal AF (3% vs. 0.2%).…”

“…The prevalence of thrombus in LA was significantly higher among patients with persistent AF in comparison to those with paroxysmal AF (3% vs. 0.2%). In addition, high thromboembolic risk (as measured by a CHADS 2 score of >2 or a CHA 2 DS 2 -VASc score of >2) was more frequently identified among patients with LA thrombus, than in those without LA (86% vs. 18% for CHADS 2 >2 and 100% vs. 33% for CHA 2 DS 2 -VASc >2, respectively) [143]. The finding of both scores <2 had almost maximal negative predictive value for the presence of thrombus in the LA appendage (99.8% for the CHADS 2 and 100% for the CHA 2 DS 2 -VASc score).…”

Left Atrial Function: Modern Assessment Methods and Clinical Significance

“…Согласно имеющимся рекомендациям выполне-ние ЧПЭхоКГ перед восстановлением ритма показано всем пациентам с продолжительностью аритмии >48 ч, не принимавшим антикоагулянтной терапии в предшествующие 3 нед [46][47]. Можно предположить, что у пациентов, принимающих антикоагулянты, или у лиц с низким риском тромбообразования можно воз-держаться от проведения этого исследования [48]. Однако зачастую практически всем пациентам, под-вергающимся катетерной абляции, проводится ЧПЭхоКГ.…”