Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Kenneth C BilchickMichael Salerno

Abstract

Computed tomography angiography (CTA) can identify and rule out left atrial appendage (LAA) thrombus when delayed imaging is also performed. In patients referred for CTA to evaluate pulmonary vein anatomy before the ablation of atrial fibrillation (AF) or left atrial flutter (LAFL), we sought to determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed LAA imaging into preprocedure care. After making delayed imaging of the LAA part of our routine preablation CTA protocol, we integrated early reporting of preablation CTA LAA imaging results into clinical practice as part of a formal protocol in June 2013. We then analyzed the effectiveness of this protocol by evaluating 320 AF/LAFL ablation patients with CTA imaging during the time period 2012-2014. In CTA patients with delayed LAA imaging, the sensitivity and negative predictive values for LAA thrombus using intracardiac echocardiography or transesophageal echocardiography (TEE) as the reference standard were both 100%. Intracardiac echocardiography during ablation confirmed the absence of thrombus in patients with negative CTA or negative TEE results. No patients with either negative CTA results or equivocal CTA results combined with negat...Continue Reading

References

Feb 24, 2001·Journal of the American College of Cardiology·S S ChughB J Gersh
May 7, 2008·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Ri Bo TangChang Sheng Ma
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Sep 3, 2010·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Suraj KapaPeter A Brady

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Citations

Sep 20, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Nilesh Mathuria
Jun 14, 2016·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Hideyuki KishimaTohru Masuyama
Sep 16, 2017·Journal of Thoracic Imaging·Fernanda ErthalBenjamin J W Chow
Jun 14, 2018·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Wael AlqarawiMouhannad M Sadek
Jul 28, 2018·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Marc KottmaierIsabel Deisenhofer
Feb 1, 2017·JACC. Clinical Electrophysiology·Alexander Sedaghat, Christoph Hammerstingl

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