Impact of dense “smoke” detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation

Ömer Gedikli, Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Qiong Chen, Domenico Giovanni Della Rocca, J. David Burkhardt, Javier E. Sanchez, Patrick Hranitzky, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney Horton, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Spontaneous echocardiographic contrast (”smoke”) within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. Objective: The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. Methods: A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS 2 VASc score). Results: In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13%) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6%) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70%) TE complications (6 TIA, 10 stroke) in group 2 (P =.004). In the propensity-matched population, 6 (2.56%) TE complications occurred in group 1 and 1 (0.2%) in group 2 (P =.007). Conclusion: In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA 2 DS 2 -VASc score.

Original languageEnglish (US)
Pages (from-to)351-357
Number of pages7
JournalHeart Rhythm
Issue number3
StatePublished - Mar 2019


  • Atrial fibrillation
  • CHA DS -VASc score
  • Smoke
  • Stroke
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


Dive into the research topics of 'Impact of dense “smoke” detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation'. Together they form a unique fingerprint.

Cite this