Two things: TEE & Amiodarone

I understand some doctors perform a TEE even when a patient has been continuously on anti coagulant medication, Thoughts?

Some doctors allow patients on Amiodarone to stay on it to the day of ablation, and a few months afterward. Thoughts?

Another reason could be (happened to me) if one flew international within the prior ten days, and even though on Eliquis, a Tee was required before a cardio version was permitted. Maybe it was that ERs guideline.

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Lani Belisle
I understand some doctors perform a TEE even when a patient has been continuously on anti coagulant medication, Thoughts?

Some doctors allow patients on Amiodarone to stay on it to the day of ablation, and a few months afterward. Thoughts?

Hard to say why a doctor might require a TEE despite continuous anticoagulation for >3 weeks. It could be specific patient characteristics, or it could be them simply being very conservative. The stats on patient compliance with anticoagulants are actually pretty poor.

As for allowing patients to remain on amiodarone up until the day of ablation, I don't think you'll find top EPs doing that. It might keep patients happy, but if they're an EP capable of doing competent mapping of AF sources by provoking it during the procedure, they're going to want you completely free of drugs that suppress AF. The trouble with amiodarone is, unlike most antiarrhythmics where you can stop them just days before the procedure, amiodarone takes a month or more to clear from your system, so that's going to be an unhappy patient for a month or more.

Before my first attempt at ablation in 2002 in Bordeaux I had a TEE/TOE. I had been on Warfarin for 18 months and been meticulous about keeping my INR in the required range. They still found a clot behind the heart so the ablation had to be postponed. Might be different with the newer OACs.

Gill

That is sobering. what is and OAC? When did you get your first ablation in Bordeaux?

OAC = oral anti-coagulant

LaniB

January 2003. I’ve written about it many times here, try searching my name

Gill