Repeat ablation
At repeat ablation, CHADS2 and
CHA2DS2-VASc scores increased
significantly and there was an improvement in LVEF (Table 2). TEE and
contrast-enhanced CT imaging were performed in 356 (58%) and 408
patients (66%), respectively. Twenty-three patients refused to undergo
TEE at the repeat ablation, mostly due to the difficulty in swallowing
the probe, but all patients underwent some alternative imaging
examination. A total of 476
patients (77%) underwent at least one imaging modality to evaluate LA
thrombi before the repeat procedure. One hundred and eighteen patients
(19%) had an interruption of oral anticoagulants before the repeat
session, and 142 patients (23%) exhibited a non-paroxysmal atrial
arrhythmia after the first ablation. Changes in coagulation markers and
TEE findings from the first to the repeat ablation are shown in Table 3.
At the repeat ablation, 72 patients switched from warfarin to DOAC,
while six patients switched from DOAC to warfarin. Three patients (0.8%
in TEE and 0.5% in repeat ablation) developed LA thrombi seen on TEE at
the repeat procedure. In contrast, one patient had a thromboembolic
event after the repeat ablation procedure without prior TEE evaluation.