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This editorial refers to ‘Impact of routine transoesophageal echocardiography on safety, outcomes, and cost of pulmonary vein ablation: inferences drawn from a decision analysis model’ by L.J. Gula et al. , on page 1550 and ‘Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation’ by K. Chilukuri et al. , on page 1543 Several complications may occur during or shortly after atrial fibrillation (AF) ablation. Some of them are relatively common, such as cardiac tamponade, but rarely have significant clinical consequences if managed adequately. Others are less common, such as stroke, but may lead to disabling sequelae. This has prompted the wide use of procedures and practises aimed at the reduction of cerebrovascular complications, such as high anticoagulation levels during the procedure or transoesophageal echocardiography (TEE) prior to ablation. However, neither the net clinical benefit nor the cost-effectiveness of these practises has been adequately validated. This should be considered relevant since some of these may themselves be associated with complications, limit the workflow of the ablation laboratory or increase costs. Two interesting papers in this issue of the Journal address the potential role of routine TEE prior to AF ablation.1,2The paper by Chilukuri et al. 1 assessed the potential TEE predictors of periprocedural stroke during AF ablation, other than the left atrium (LA) thrombus. This is important since the majority of studies exploring the use of TEE prior to AF ablation have … *Corresponding author: Unidad de Electrofisiologia Cardiaca Robotizada (1a Planta), Hospital General La Paz, P. de la Castellana 261, 28046 Madrid, Spain. Tel: +34 619 97 4115; fax: +34 917 27 7290, E-mail: jlmerino{at}arritmias.net

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Periprocedural stroke and atrial fibrillation ablation: to do transoesophageal echocardiography, or not to do transoesophageal echocardiography, that is the question