Conventional oral anticoagulation may not replace prior transesophageal echocardiography for the patients with planned catheter ablation for atrial fibrillation
Preablation transesophageal echocardiography (TEE) is dispensable for the patients with planned catheter ablation for atrial fibrillation (AF) and having received at least a 3-week oral anticoagulation therapy according to the recommendations of the Venice Consensus. But the role of prior TEE and the effect of preablation short-term oral anticoagulation drugs (OACs) under the circumstance are still unclear. A total of 188 patients with planned catheter ablation for AF and without previous long-term oral anticoagulation, whose duration of AF exceeded 48 h, were randomly divided into receiving 3-week OACs (OACs group) before heparin bridging or receiving no prior OACs (N-OACs group). Follow-up was performed until a TEE had been performed on all the cases before ablation. Consequently, the prevalence of atrial thrombi is 6.3% and 11.7%, respectively (P < 0.05), and the prevalence of minor bleeding is 5.3% and 0%, respectively (P < 0.05), in OACs and N-OACs group. There was no thrombotic event, major hemorrhage, in both groups. After a 3-week effective oral anticoagulation, atrial thrombi could be resolved partly but not completely in the patients with AF who had not received long-term oral anticoagulation previously. To ensure safety, prior TEE may be necessary for the patients with planned catheter ablation for AF.