Selective TEE strategy as effective as routine use of TEE before AF ablation
 

　　（2007年10月23日电）加拿大全国调查研究发现，房颤射频消融术前选择性应用经食管超声（TEE）检查与常规TEE检查在预防房颤脑栓塞事件方面一样有效。这一调查研究结果发表在2007年的加拿大心血管学会议上。

　　Redfear医生(Queen’s University, Kingston, ON)在他的报告中指出，这一研究结果显示在房颤射频消融术前常规进行TEE检查可能不符合费用/效益比。这个研究用于评价在加拿大应用TEE的可行性，通过常规或选择性应用TEE来确定左房血栓的患病率，同时比较常规和选择性应用TEE对脑栓塞事件发生情况的影响。

　　全国性调查研究

　　调查表通过电子邮件发送到加拿大所有能够进行房颤左房消融术的电生理中心。

　　对10个中心2225例患者的资料进行回顾性分析发现（每个中心患者数量的中位数为110例，每年大致发生55例），约80%的患者为阵发性房颤。有996例患者接受常规TEE检查。总共有16例患者发现左房血栓（患病率为1.25%）。
有11例患者发生脑栓塞事件，其中9例患者先前TEE检查未发现左房血栓。栓塞发生率并不高，约为0.49%，Redfearn医生说。常规TEE检查组（996例患者中有6例患者发生栓塞事件）与选择性TEE检查组（1190例患者中有5例发生栓塞事件）的栓塞发生率之间统计学无差别。

　　Redfearn医生说，虽然在讨论这个试验结果对临床工作影响前应当对试验进行更全面的分析，但他并不认为临床工作会有什么变化。他指出：“医界同仁的主观实践经验会影响到他们的临床实践，如果他们在临床工作中常规进行TEE检查，那么他们就可能拒绝改为选择性应用TEE检查”，在他的EP中心TEE检查就是常规进行的。

　　（来源:www.theheart.org）

Selective TEE strategy as effective as routine use of TEE before AF ablation
 
October 23, 2007  
Erin O’Connell

Quebec City, QC - Selective use of transesophageal echocardiography (TEE) appeared to be as effective at preventing embolic events as routine use in a cross-Canada study looking at use of the procedure prior to left atrial ablation for atrial fibrillation (AF) [1]. The survey-based study was presented at the Canadian Cardiovascular Congress 2007.

The results indicate a potential cost-effectiveness issue with routine use, noted Dr Damian Redfearn (Queen’s University, Kingston, ON) in his presentation of the data. The study was undertaken to assess the use of TEE across Canada as well as to determine the prevalence of left atrial clot identified by routine or selected use and to compare the different practices across the country, correlating them with cerebral thromboembolic events.

Cross-country checkup

A survey was emailed to 10 Canadian electrophysiology centers that practice left atrial ablation for AF.
 

If they do routine TEE, they’re resistant to change.  

Retrospective analysis on data from all 10 centers revealed a total of 2225 cases of AF, with a median of 110 per center, or roughly 55 per year. The great majority—80%—of cases were paroxysmal AF. TEE was performed in a total of 1194 cases. Routine TEE was performed in 996 patients. A total of 16 left atrial clots were identified (prevalence of 1.25%).

Eleven cerebroembolic events were observed, nine with previous negative TEE. At an incidence of 0.49%, the rate of thromboembolic complications is low, observed Redfearn. No difference was seen in the rate of embolic complications between routine TEE (six of 996 cases) and selected TEE (five of 1190 cases), and there were no reported complications from TEE use.

Although he feels a more comprehensive analysis is needed before talking of clinical impact, he doesn’t foresee a change in practice. "The images and the subjective experience of colleagues are such that, if they do routine TEE, they’re resistant to change," he noted, adding that his center performs routine TEE.