Can transesophageal echocardiography be safely omitted in patients scheduled for elective ablation of atrial...

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Current guidelines do not mandate transesophageal echocardiography (TEE) before catheter ablation (CA) for atrial arrhythmias in anticoagulated patients.
• Clinical practice often deviates from these recommendations, with TEE frequently performed.
• This discrepancy highlights a need for better patient selection strategies.

Purpose of the Study:

• To identify transthoracic echocardiographic (TTE) parameters indicative of the absence of left atrial thrombus (LAT).
• To enable the omission of TEE in selected patients undergoing CA for atrial fibrillation (AF) or atrial flutter (AFL).
• To reduce unnecessary invasive procedures and associated risks.

Main Methods:

• Sub-analysis of the multicenter, prospective, observational LATTEE registry.
• Inclusion of 1346 patients scheduled for TEE prior to CA for AF/AFL.
• Analysis of clinical data and echocardiographic parameters to predict LAT absence.

Main Results:

• Left atrial thrombus (LAT) was found in 3.3% of patients.
• Patients without LAT were younger, more likely to have paroxysmal AF, and had lower rates of comorbidities.
• Specific TTE parameters (LVEF >65%, LAD <40 mm, LAA <20 cm², LAV <113 ml, LAVI <51 ml/m²) showed 100% sensitivity and negative predictive value for LAT absence.
• Combined echocardiographic indices identified an additional 35% of patients as LAT-free.

Conclusions:

• Simple echocardiographic parameters can effectively identify patients without left atrial thrombus.
• These findings suggest that TEE can be safely omitted before elective CA in selected patients.
• This strategy may optimize patient care and resource utilization.