Routine Trans-Esophageal Echo before Redo Atrial Fibrillation Ablation, is it Necessary?

Background: Catheter ablation has emerged as an effective procedure for rhythm control for patients (pts) with symptomatic atrial fibrillation (AF). To rule out a left atrial (LA) thrombus, it is recommended to perform trans-esophageal echo (TEE) before the ablation. The necessity of routine TEE before redo ablation for pts on chronic anticoagulation with recurrence of AF is questionable.

Objective: The aim of this retrospective comparative pilot study was to assess the safety of redo AF ablation performed without pre-procedural TEE in pts on chronic oral anticoagulation treatment.

Methods: 17 consecutive pts who underwent redo pulmonary vein isolation (PVI) ablation in our hospital between 2014 and 2018 were included in this retrospective as a pilot for prospective study. Seven of them underwent a TEE prior to the redo procedure and ten did not. All pts had TEE before the first ablation and were treated with oral anticoagulation.

Results: 88% of the pts were male, the mean age was 61 year. Mean CHA₂ DS _2-VASc score was 2.11. Mean LA diameter was 41.4 mm. Mean LVEF was 61%. 23% of the pts were in persistent AF before redo PVI. Mean time to redo PVI was 20 months. There were no differences between the groups in baseline characteristics Mean follow-up was 12 months. One patient in the pre-ablation TEE group had a recurrence of AF versus 2 pts in the non-TEE group (p<0.77). No cerebrovascular event or other cardio-embolic event was observed in either group. There was no mortality.

Conclusions: In this preliminary study, redo ablation for AF without pre-procedural TEE in patients on chronic anticoagulation therapy was safe. Prospective trial is to be started shortly.