Predictive value of thromboembolic risk scores before an atrial fibrillation ablation procedure.
J Cardiovasc Electrophysiol
; 24(2): 139-45, 2013 Feb.
Article
em En
| MEDLINE
| ID: mdl-23066657
ABSTRACT
INTRODUCTION:
It is not clear whether transesophageal echocardiography (TEE) should be performed prior to a planned atrial fibrillation (AF) ablation in all patients. METHODS ANDRESULTS:
The objectives of this study were to determine in 681 consecutive patients (i) the relationship between the CHADS2 and CHA2DS2-VASc scores, the presence of a thrombogenic milieu and left atrial (LA) volume; (ii) the need for TEE in patients with low and intermediate thromboembolic risk assessed; and (iii) the predictive accuracy of the these 2 scores for the presence of thrombi in the LA/LAA (LA appendage) before a planned AF ablation. The prevalence of thrombi was 1%. All patients with thrombi had LA dilatation, a CHADS2 score ≥ 1 and a CHA2DS2-VASc score ≥ 2. CHADS2 or CHA2DS2-VASc scores <2 had an almost maximal negative predictive capability of excluding the presence of a thrombus (99.8% and 100%, respectively; 95% CI 99-100). A CHADS2 score ≥ 2 had a sensitivity and specificity of 86% (95% CI 42-100) and 82% (95% CI 79-85), respectively, to predict the presence of a thrombus in the LA/LAA, while a CHA2DS2-VASc score ≥ 2 had a sensitivity and specificity of 100% (95% CI 59-100) and 67% (95% CI 63-70). The area under the curve for CHADS2 and CHA2DS2-VASc scores ≥ 2 was 0.928 (95% CI 0.906-0.946) and 0.933 (95% CI 0.912-0.951), respectively.CONCLUSION:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Tromboembolia
/
Ablação por Cateter
/
Ecocardiografia Transesofagiana
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Cardiovasc Electrophysiol
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
FISIOLOGIA
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Bélgica