Transesophageal Echocardiography for the Prevention of Embolic Complications After Catheter Ablation for Atrial Fibrillation
Bibliographic record
Abstract
BACKGROUND: Thromboembolic complications during left-sided ablations range between 1.5 and 5.4%. Preprocedural TEE has been used to exclude the presence of left atrial thrombi in order to minimize risk. The use of TEE is empiric and it has not been evaluated in contemporary practice. METHODS AND RESULTS: A multicenter national survey describing the practice at 11 Canadian teaching hospitals. A total of 2,225 patients underwent elective catheter ablation for symptomatic AF. Transesophageal echocardiography (TEE) was used either routinely or selectively as a preablative strategy in patients. There were 996 patients in a routine preprocedure TEE strategy and 1,190 in a selected TEE strategy; 1 center (n = 39 patients) did not perform TEE. Twelve of 996 (1.2%) in the routine unselected cohort had thrombi identified. TEEs were performed in 200 of 1,190 in the selected cohort; 4 (2.0%) left atrial thrombi were observed; there was no significant difference in the prevalence of thrombi (P = 0.34). A total of 11 embolic events occurred inclusive of all groups. There was no difference in event rates between the 2 strategies (0.6% and 0.4%, P = 0.54). Events were unrelated to AF duration (persistent vs paroxysmal, r = 0.03, N = 2,225, P = 0.9). CONCLUSION: The selection criteria employed to perform TEEs did not increase the chance of identifying LA thrombi in a patient cohort with primarily nondilated left atria and paroxysmal AF. The overall thromboembolic event rate was low (0.49%) and was not significantly different between the 2 TEE strategies.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".