Background:
Due to dreaded cardioembolic complications oral anticoagulation (OAC) plays a key role in patients with atrial fibrillation (AF). Prior to planned rhythm control, transesophageal echocardiography (TEE) is recommended to rule out left atrial thrombi (LAT) in cases of inadequate oral anticoagulation. It is currently unknown whether low-risk AF patients always require TEE before. The aim of this study was to examine this question.
Methods and results: We examined digitalized clinical routine data from electronic medical records of the Heart Center Leipzig between January 1, 2010, and December 31, 2022. Patients with a low-risk profile (CHA2DS2-VA score 0) were selected and underwent manual data check. Primary endpoint was detection of LAT by TEE.
701 patient cases, with 602 individual patients, were included. Median age was 52 years (interquartile range [IQR] 13 years) and 4.7% were female. In 97.9% TEE was performed prior to rhythm control therapy (pharmacological or electrical cardioversion (42.9%) and catheter ablation (54.9%)). OAC was sufficient in 16.4%, considered insufficient in 22.4%, and there was no kind of OAC in 61.1% of cases. LAT was detected in only one individual (0.1%), in whom rhythm control therapy was not performed. In another 11 patients spontaneous contrast (atrial “sludge”) was described. The intended rhythm control therapy was performed in all these patients without any adverse events in short-term follow-up.
Conclusion: Based on our data, routine TEE in low risk patients does not appear to be required. In addition to CHA2DS2-VA score, other risk factors should be considered in clinical routine.
