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Transoesophageal echocardiography prior to catheter ablation could be avoided in atrial fibrillation patients with a low risk of stroke and without filling defects in the late-phase MDCT scan: A retrospective analysis of 783 patients

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To test whether multidetector computed tomography (MDCT) could completely replace transoesophageal echocardiography (TEE) to detect left atrial appendage (LAA) thrombi in atrial fibrillation (AF) patients using a large sample size.

Methods

783 patients with AF who underwent MDCT and TEE before catheter ablation were retrospectively included. Demographic data were obtained. Two radiologists blinded to clinical data made the imaging diagnosis.

Results

Most of the patients (96.2 %) had a CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥ 75 years old (doubled), diabetes, stroke/transient ischaemic attack/thromboembolism (doubled), vascular disease, age 65–74 years, female sex) ≤ 3. Eight thrombi were identified by TEE, all of which were detected by MDCT; no thrombus was observed with TEE without the observation of filling defects by late-phase MDCT scanning in any of the patients. Using TEE as reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of MDCT for thrombus detection were 100 %, 95.74 % (95 % CI 94.33 %–97.15 %), 19.51 % (95 % CI 16.73 %–22.29 %) and 100 %, respectively.

Conclusions

For AF patients with low risk of stroke, when MDCT images showed no filling defect in the late phase, TEE prior to catheter ablation can be avoided.

Key Points

• MDCT can help detect the presence of LAA thrombus.

• TEE can be avoided when late-phase MDCT shows no filling defect.

• TEE is required in patients whose MDCT images indicate thrombus.

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Abbreviations

AF:

Atrial fibrillation

CA:

Catheter ablation

CHA2DS2-VASc:

Congestive heart failure, hypertension, age ≥ 75 years (doubled), diabetes previous stroke/transient ischaemic attack/thromboembolism (doubled), vascular disease, age 65–74 years, and sex category (female)

CHF:

Congestive heart failure

LAA:

Left atrial appendage

LAD:

Left atrial dimension

LVEDD:

Left ventricular end-diastolic dimension

LVEF:

Left ventricular ejection fraction

MDCT:

Multidetector computed tomography

SEC:

Spontaneous echo contrast

TEE:

Transoesophageal echocardiography

TIA:

Transient ischaemic attack

VASc:

Vascular diseases

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Acknowledgements

The authors thank Lei Han for MDCT consulting services.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, NO.167, Beilishi Road, Xicheng District, Beijing, China

    Zhengqin Zhai, Min Tang, Shu Zhang, Pihua Fang, Yuhe Jia, Tianjie Feng & Jiande Wang

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  1. Zhengqin Zhai
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  2. Min Tang
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  7. Jiande Wang
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Corresponding author

Correspondence to Min Tang.

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The scientific guarantor of this publication is Min Tang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Zhai, Z., Tang, M., Zhang, S. et al. Transoesophageal echocardiography prior to catheter ablation could be avoided in atrial fibrillation patients with a low risk of stroke and without filling defects in the late-phase MDCT scan: A retrospective analysis of 783 patients. Eur Radiol 28, 1835–1843 (2018). https://doi.org/10.1007/s00330-017-5172-6

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  • DOI: https://doi.org/10.1007/s00330-017-5172-6

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