User menu

Accès à distance ? S'identifier sur le proxy UCLouvain

Predictive value of thromboembolic risk scores before an atrial fibrillation ablation procedure

Primary tabs

Floria, Mariana [UCL] De Roy, Lucas [UCL] Xhaet, Olivier [UCL] Blommaert, Dominique [UCL] Jamart, Jacques [UCL] GERARD, Marina [UCL] DORMAL, Fabien [UCL] Deceuninck, Olivier [UCL] Marchandise, Baudouin [UCL] Schroeder, Erwin [UCL]

Risk Scores for Atrial Fibrillation Ablation Introduction: It is not clear whether transesophageal echocardiography (TEE) should be performed prior to a planned atrial fibrillation (AF) ablation in all patients. Methods and Results: 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. © 2012 Wiley Periodicals, Inc.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2013
Language Anglais
Journal information "Journal of Cardiovascular Electrophysiology" - Vol. 24, no.2, p. 139-145 (2013)
Peer reviewed yes
Publisher Wiley-Blackwell Publishing, Inc. ((United States) Malden)
issn 1045-3873
e-issn 1540-8167
Publication status Publié
Affiliations UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - SSS/IRSS - Institut de recherche santé et société
UCL - SSS/IREC/MONT - Pôle Mont Godinne
UCL - (MGD) Service de cardiologie
UCL - (MGD) Unité de support scientifique
Keywords Anticoagulation ; Atrial fibrillation ; Catheter ablation ; CHADS ; CHADS 2-VASc ; Thromboembolic risk ; Trans-oesophageal echocardiography
Links
  1. Calkins Hugh, Brugada Josep, Packer Douglas L., Cappato Riccardo, Chen Shih-Ann, Crijns Harry J.G., Damiano Ralph J., Davies D. Wyn, Haines David E., Haissaguerre Michel, Iesaka Yoshito, Jackman Warren, Jais Pierre, Kottkamp Hans, Kuck Karl Heinz, Lindsay Bruce D., Marchlinski Francis E., McCarthy Patrick M., Mont J. Lluis, Morady Fred, Nademanee Koonlawee, Natale Andrea, Pappone Carlo, Prystowsky Eric, Raviele Antonio, Ruskin Jeremy N., Shemin Richard J., HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up, 10.1016/j.hrthm.2007.04.005
  2. Calkins H., Kuck K. H., Cappato R., Brugada J., Camm A. J., Chen S.-A., Crijns H. J. G., Damiano R. J., Davies D. W., DiMarco J., Edgerton J., Ellenbogen K., Ezekowitz M. D., Haines D. E., Haissaguerre M., Hindricks G., Iesaka Y., Jackman W., Jalife J., Jais P., Kalman J., Keane D., Kim Y.-H., Kirchhof P., Klein G., Kottkamp H., Kumagai K., Lindsay B. D., Mansour M., Marchlinski F. E., McCarthy P. M., Mont J. L., Morady F., Nademanee K., Nakagawa H., Natale A., Nattel S., Packer D. L., Pappone C., Prystowsky E., Raviele A., Reddy V., Ruskin J. N., Shemin R. J., Tsao H.-M., Wilber  D., Calkins H., Kuck K. H., Cappato R., Chen S.-A., Prystowsky E. N., Kuck K. H., Natale A., Haines D. E., Marchlinski F. E., Calkins H., Davies D. W., Lindsay B. D., Damiano R., Packer D. L., Brugada J., Camm A. J., Crijns H. J. G., DiMarco J., Edgerton J., Ellenbogen K., Ezekowitz M. D., Haissaguerre M., Hindricks G., Iesaka Y., Jackman W. M., Jais P., Jalife J., Kalman J., Keane D., Kim Y.-H., Kirchhof P., Klein G., Kottkamp H., Kumagai K., Mansour M., Marchlinski F., McCarthy P., Mont J. L., Morady F., Nademanee K., Nakagawa H., Nattel S., Pappone C., Raviele A., Reddy V., Ruskin J. N., Shemin R. J., Tsao H.-M., Wilber D., Ad N., Cummings J., Gillinov A. M., Heidbuchel H., January C., Lip G., Markowitz S., Nair M., Ovsyshcher I. E., Pak H.-N., Tsuchiya T., Shah D., Siong T. W., Vardas P. E., , , , , 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society, 10.1093/europace/eus027
  3. , Fuster V., Ryden L. E., Cannom D. S., Crijns H. J., Curtis A. B., Ellenbogen K. A., Halperin J. L., Le Heuzey J.-Y., Kay G. N., Lowe J. E., Olsson S. B., Prystowsky E. N., Tamargo J. L., Wann S., Smith S. C., Jacobs A. K., Adams C. D., Anderson J. L., Antman E. M., Halperin J. L., Hunt S. A., Nishimura R., Ornato J. P., Page R. L., Riegel B., Priori S. G., Blanc J.-J., Budaj A., Camm A. J., Dean V., Deckers J. W., Despres C., Dickstein K., Lekakis J., McGregor K., Metra M., Morais J., Osterspey A., Tamargo J. L., Zamorano J. L., , , ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society, 10.1093/europace/eul097
  4. , Camm A. J., Kirchhof P., Lip G. Y. H., Schotten U., Savelieva I., Ernst S., Van Gelder I. C., Al-Attar N., Hindricks G., Prendergast B., Heidbuchel H., Alfieri O., Angelini A., Atar D., Colonna P., De Caterina R., De Sutter J., Goette A., Gorenek B., Heldal M., Hohloser S. H., Kolh P., Le Heuzey J.-Y., Ponikowski P., Rutten F. H., Vahanian A., Auricchio A., Bax J., Ceconi C., Dean V., Filippatos G., Funck-Brentano C., Hobbs R., Kearney P., McDonagh T., Popescu B. A., Reiner Z., Sechtem U., Sirnes P. A., Tendera M., Vardas P. E., Widimsky P., Vardas P. E., Agladze V., Aliot E., Balabanski T., Blomstrom-Lundqvist C., Capucci A., Crijns H., Dahlof B., Folliguet T., Glikson M., Goethals M., Gulba D. C., Ho S. Y., Klautz R. J. M., Kose S., McMurray J., Perrone Filardi P., Raatikainen P., Salvador M. J., Schalij M. J., Shpektor A., Sousa J., Stepinska J., Uuetoa H., Zamorano J. L., Zupan I., , , , , Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC), 10.1093/eurheartj/ehq278
  5. NATALE ANDREA, RAVIELE ANTONIO, ARENTZ THOMAS, CALKINS HUGH, CHEN SHIH-ANN, HAÏSSAGUERRE MICHEL, HINDRICKS GERHARD, HO YEN, KUCK KARL HEINZ, MARCHLINSKI FRANCIS, NAPOLITANO CARLO, PACKER DOUGLAS, PAPPONE CARLO, PRYSTOWSKY ERIC N., SCHILLING RICHARD, SHAH DIPEN, THEMISTOCLAKIS SAKIS, VERMA ATUL, Venice Chart International Consensus Document on Atrial Fibrillation Ablation, 10.1111/j.1540-8167.2007.00816.x
  6. FLACHSKAMPF F, DECOODT P, FRASER A, DANIEL W, ROELANDT J, Recommendations for Performing Transoesophageal Echocardiography, 10.1016/s1525-2167(00)90066-0
  7. Flachskampf F. A., Badano L., Daniel W. G., Feneck R. O., Fox K. F., Fraser A. G., Pasquet A., Pepi M., Perez de Isla L., Zamorano J. L., Roelandt J. R. T. C., Pierard L., , , Recommendations for transoesophageal echocardiography: update 2010, 10.1093/ejechocard/jeq057
  8. Aschenberg Wolfgang, Schlüter Michael, Kremer Peter, Schröder Erwin, Siglow Volker, Bleifeld Walter, Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus, 10.1016/s0735-1097(86)80275-3
  9. Fatkin Diane, Kelly Raymond P., Feneley Michael P., Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo, 10.1016/0735-1097(94)90644-0
  10. Puwanant Sarinya, Varr Brandon C., Shrestha Kevin, Hussain Sarah K., Tang W.H. Wilson, Gabriel Ruvin S., Wazni Oussama M., Bhargava Mandeep, Saliba Walid I., Thomas James D., Lindsay Bruce D., Klein Allan L., Role of the CHADS2Score in the Evaluation of Thromboembolic Risk in Patients With Atrial Fibrillation Undergoing Transesophageal Echocardiography Before Pulmonary Vein Isolation, 10.1016/j.jacc.2009.07.037
  11. Dorekamp, Int J Cardiol (2011)
  12. KHAN MOHAMMED N., USMANI ALI, NOOR SAIRA, ELAYI SAMY, CHING CHI KEONG, BIASE LUIGI DI, PATEL DIMPI, BURKHARDT J. DAVID, CUMMINGS JENNIFER, SCHWEIKERT ROBERT, SALIBA WALID, NATALE ANDREA, Low Incidence of Left Atrial or Left Atrial Appendage Thrombus in Patients with Paroxysmal Atrial Fibrillation and Normal EF Who Present for Pulmonary Vein Antrum Isolation Procedure, 10.1111/j.1540-8167.2007.01070.x
  13. Zabalgoitia Miguel, Halperin Jonathan L, Pearce Lesly A, Blackshear Joseph L, Asinger Richard W, Hart Robert G, Transesophageal Echocardiographic Correlates of Clinical Risk of Thromboembolism in Nonvalvular Atrial Fibrillation, 10.1016/s0735-1097(98)00146-6
  14. Predictors of Thromboembolism in Atrial Fibrillation: II. Echocardiographic Features of Patients at Risk, 10.7326/0003-4819-116-1-6
  15. Predictors of Thromboembolism in Atrial Fibrillation: I. Clinical Features of Patients at Risk, 10.7326/0003-4819-116-1-1
  16. Wazni Oussama M., Tsao Hsuan-Ming, Chen Shih-Ann, Chuang Hsuan-Hung, Saliba Walid, Natale Andrea, Klein Allan L., Cardiovascular Imaging in the Management of Atrial Fibrillation, 10.1016/j.jacc.2006.06.072
  17. Rader Valerie J., Khumri Taiyeb M., Idupulapati Madhuri, Stoner Casey N., Magalski Anthony, Main Michael L., Clinical Predictors of Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Patients with Atrial Fibrillation, 10.1016/j.echo.2007.02.010
  18. Agmon Yoram, Khandheria Bijoy K., Meissner Irene, Petterson Tanya M., O'Fallon W.Michael, Wiebers David O., Seward James B., Are left atrial appendage flow velocities adequate surrogates of global left atrial function? A population-based transthoracic and transesophageal echocardiographic study, 10.1067/mje.2002.116826
  19. McCready J. W., Nunn L., Lambiase P. D., Ahsan S. Y., Segal O. R., Rowland E., Lowe M. D., Chow A. W., Incidence of left atrial thrombus prior to atrial fibrillation ablation: is pre-procedural transoesophageal echocardiography mandatory?, 10.1093/europace/euq074
  20. Wallace, J Cardiovasc Electrophysiol, 21, 849 (2010)
  21. Gopinath, J Cardiovasc Electrophysiol, 22, 236 (2011)
Bibliographic reference Floria, Mariana ; De Roy, Lucas ; Xhaet, Olivier ; Blommaert, Dominique ; Jamart, Jacques ; et. al. Predictive value of thromboembolic risk scores before an atrial fibrillation ablation procedure. In: Journal of Cardiovascular Electrophysiology, Vol. 24, no.2, p. 139-145 (2013)
Permanent URL http://hdl.handle.net/2078.1/126471