Periprocedural stroke and atrial fibrillation ablation: to do transoesophageal echocardiography, or not to do transoesophageal echocardiography, that is the question.

摘要

Several complications may occur during or shortly after atrial fibrillation (AF) ablation. Some of them are relatively common, such as cardiac tamponade, but rarely have significant clinical consequences if managed adequately. Others are less common, such as stroke, but may lead to disabling sequelae. This has prompted the wide use of procedures and practises aimed at the reduction of cerebrovascular complications, such as high anticoagulation levels during the procedure or transoesophageal echocardiography (TEE) prior to ablation. However, neither the net clinical benefit nor the cost-effectiveness of these practises has been adequately validated. This should be considered relevant since some of these may themselves be associated with complications, limit the workflow of the ablation laboratory or increase costs. Two interesting papers in this issue of the Journal address the potential role of routine TEE prior to AF ablation.