Impact of dense “smoke” detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation

Ömer Gedikli, Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Qiong Chen, Domenico Giovanni Della Rocca, J. David Burkhardt, Javier E. Sanchez, Patrick Hranitzky, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney Horton, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Spontaneous echocardiographic contrast (”smoke”) within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. Objective: The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. Methods: A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS2VASc score). Results: In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13%) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6%) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70%) TE complications (6 TIA, 10 stroke) in group 2 (P =.004). In the propensity-matched population, 6 (2.56%) TE complications occurred in group 1 and 1 (0.2%) in group 2 (P =.007). Conclusion: In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA2DS2-VASc score.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Catheter Ablation
Transesophageal Echocardiography
Smoke
Atrial Fibrillation
Transient Ischemic Attack
Stroke
Propensity Score
Blood Flow Velocity
Population

Keywords

  • Atrial fibrillation
  • CHADS-VASc score
  • Smoke
  • Stroke
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Impact of dense “smoke” detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation. / Gedikli, Ömer; Mohanty, Sanghamitra; Trivedi, Chintan; Gianni, Carola; Chen, Qiong; Della Rocca, Domenico Giovanni; Burkhardt, J. David; Sanchez, Javier E.; Hranitzky, Patrick; Gallinghouse, G. Joseph; Al-Ahmad, Amin; Horton, Rodney; Di Biase, Luigi; Natale, Andrea.

In: Heart Rhythm, 01.01.2019.

Research output: Contribution to journalArticle

Gedikli, Ö, Mohanty, S, Trivedi, C, Gianni, C, Chen, Q, Della Rocca, DG, Burkhardt, JD, Sanchez, JE, Hranitzky, P, Gallinghouse, GJ, Al-Ahmad, A, Horton, R, Di Biase, L & Natale, A 2019, 'Impact of dense “smoke” detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2018.10.004
Gedikli, Ömer ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Gianni, Carola ; Chen, Qiong ; Della Rocca, Domenico Giovanni ; Burkhardt, J. David ; Sanchez, Javier E. ; Hranitzky, Patrick ; Gallinghouse, G. Joseph ; Al-Ahmad, Amin ; Horton, Rodney ; Di Biase, Luigi ; Natale, Andrea. / Impact of dense “smoke” detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation. In: Heart Rhythm. 2019.
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abstract = "Background: Spontaneous echocardiographic contrast (”smoke”) within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. Objective: The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. Methods: A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS2VASc score). Results: In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13{\%}) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6{\%}) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70{\%}) TE complications (6 TIA, 10 stroke) in group 2 (P =.004). In the propensity-matched population, 6 (2.56{\%}) TE complications occurred in group 1 and 1 (0.2{\%}) in group 2 (P =.007). Conclusion: In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA2DS2-VASc score.",
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T1 - Impact of dense “smoke” detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation

AU - Gedikli, Ömer

AU - Mohanty, Sanghamitra

AU - Trivedi, Chintan

AU - Gianni, Carola

AU - Chen, Qiong

AU - Della Rocca, Domenico Giovanni

AU - Burkhardt, J. David

AU - Sanchez, Javier E.

AU - Hranitzky, Patrick

AU - Gallinghouse, G. Joseph

AU - Al-Ahmad, Amin

AU - Horton, Rodney

AU - Di Biase, Luigi

AU - Natale, Andrea

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Spontaneous echocardiographic contrast (”smoke”) within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. Objective: The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. Methods: A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS2VASc score). Results: In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13%) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6%) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70%) TE complications (6 TIA, 10 stroke) in group 2 (P =.004). In the propensity-matched population, 6 (2.56%) TE complications occurred in group 1 and 1 (0.2%) in group 2 (P =.007). Conclusion: In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA2DS2-VASc score.

AB - Background: Spontaneous echocardiographic contrast (”smoke”) within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. Objective: The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. Methods: A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS2VASc score). Results: In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13%) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6%) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70%) TE complications (6 TIA, 10 stroke) in group 2 (P =.004). In the propensity-matched population, 6 (2.56%) TE complications occurred in group 1 and 1 (0.2%) in group 2 (P =.007). Conclusion: In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA2DS2-VASc score.

KW - Atrial fibrillation

KW - CHADS-VASc score

KW - Smoke

KW - Stroke

KW - Transesophageal echocardiography

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