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Peter J Savill, Dhrubo J Rakhit, and Benoy N Shah

Open access

Charlotte Atkinson, Jonathan Hinton, Edmund B Gaisie, Arthur M Yue, Paul R Roberts, Dhrubo J Rakhit, and Benoy N Shah

Transoesophageal echocardiography (TOE) is frequently performed prior to atrial fibrillation (AF) ablation to exclude left atrial appendage (LAA) thrombus. However, patients undergoing AF ablation are usually anticoagulated, thus making the presence of thrombus unlikely in most cases. This study aimed to determine whether the CHA2DS2VASc scoring system can be used to identify patients that do not require TOE prior to AF ablation. In this single-centre retrospective study, local institutional and primary care databases and electronic patient records were searched to identify patients that had undergone TOE prior to AF ablation. Patient demographics, CHA2DS2VASc score, TOE findings and anticoagulation status were collected for analysis. Over a 7-year period (2008–2014), 332 patients (age 57 ± 10 years; 74% male) underwent TOE prior to proposed AF ablation. CHA2DS2VASc scores of 0, 1, 2 and >2 were found in 39, 34, 15 and 12% of patients, respectively. The prevalence of LAA thrombus was 0.6% (2 patients) and these 2 patients had risk scores of 2 and 4. No patients with a score of 0 or 1 had LAA thrombus. Patients that are classed as low risk by the CHA2DS2VASc score do not require a pre-ablation TOE to screen for LAA thrombus provided they are adequately anticoagulated. This would lead to a significant reduction in health care expenditures by reducing unnecessary TOE requests and thereby improve patient experience.

Open access

Richard P Steeds, Martin R Cowie, Bushra S Rana, John B Chambers, Simon Ray, Janaki Srinivasan, Konstantin Schwarz, Christopher J Neil, Caroline Scally, John D Horowitz, Michael P Frenneaux, Cristina Pislaru, Dana K Dawson, Oliver J Rothwell, Keith George, John D Somauroo, Rachel Lord, Mike Stembridge, Rob Shave, Martin Hoffman, Euan A Ashley, Francois Haddad, Thijs M H Eijsvogels, David Oxborough, Reinette Hampson, Chris D Kinsey, Sothinathan Gurunathan, Anastasia Vamvakidou, Nikolaos Karogiannis, Roxy Senior, Shahram Ahmadvazir, Benoy N Shah, Konstantinos Zacharias, Dan Bowen, Shaun Robinson, Ugochukwu Ihekwaba, Karen Parker, James Boyd, Cameron G Densem, Charlotte Atkinson, Jonathan Hinton, Edmund B Gaisie, Dhrubo J Rakhit, Arthur M Yue, Paul R Roberts, Dean Thomas, Pat Phen, Jonathan Sibley, Sarah Fergey, and Paul Russhard