Implementation and first outcomes of a novel standard operating procedure for preprocedural transoesophageal echocardiography screening in course of atrial arrhythmia ablation.

Abstract

Preprocedural TEE screening for LA thrombi is standard of care in many centers performing AF ablation. However, TEE imposes procedural risks for patients and is often challenging to implement in daily practice, besides causing patient discomfort. At our center, a novel standard operating procedure (SOP) was implemented, aiming to identify patients that can be exempt from TEE screening. We aimed to assess, whether this screening approach may reduce preprocedural TEEs without imposing patients of higher risks for cerebrovascular events (CVE). Data of 1874 consecutive patients treated by catheter ablation of left atrial arrhythmias between 2018 and 2022 was retrospectively analyzed. A cohort of 937 patients, where decision to perform TEE screening was based on a new SOP (considering rhythm at admission, CHA2DS2-VASc-Score, sufficient anticoagulation), was compared to a matched cohort receiving TEE before every procedure. Number of performed TEEs and incidences of CVEs were compared. Implementation of the new SOP led to a 67% reduction in TEEs performed (old SOP: 933 vs. new SOP: 305). No significant differences between the groups were detected regarding TIA (old SOP: 5 vs. new SOP: 3; p = 0.48) and stroke (no events). No solid thrombi were detected during TEE screening. The number of preprocedural screening TEEs before AF ablation procedures can be safely reduced by applying risk stratification based on rhythm at admission and CHA2DS2-VASc-Score, if anticoagulation was performed properly.