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Exclusion of left atrial thrombus by dual-source cardiac computed tomography prior to catheter ablation for atrial fibrillation

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Abstract

Objectives

Thromboembolic complications during atrial fibrillation (AF) ablation due to mobilisation of a pre-existing thrombus formation (TF) in the left atrium (LA) are devastating. The gold standard to exclude LA TF is transesophageal echocardiography (TEE). The present study compares sensitivity and specificity of a dual-source cardiac-computed tomography (DS-CT) with TEE for TF exclusion prior to AF ablation. In addition, CT protocols with and without ECG synchronized were evaluated.

Methods

In 622 patients, DS-CT as well as TEE to exclude TF was performed less than 48 h prior to AF ablation. Mean age of patients was 60 ± 10 years (69% males, 61% paroxysmal AF). During DS-CT, 280 patients (45%) were in AF. An ECG-synchronized DS-CT was performed in 332 patients, whereas 290 patients underwent DS-CT without ECG synchronization.

Results

In all patients without suspected TF on DS-CT (n = 552; 88.7%), no thrombus was found on TEE. A TF was suspected on DS-CT in 70 patients, of whom only three patients showed TF on TEE. No TF was detected in the other 67 patients (Fig. 1). Overall, sensitivity for TF detection in DS-CT was 100% and specificity was 89.2% (positive predictive value 4.3%, negative predictive value 100%). The CT protocol (ECG-synchronized versus non-ECG-synchronized) had no significant influence on diagnostic accuracy. Mean dose length product during DS CT was 282 ± 287 mGy cm (synchronized) versus 136 ± 55 mGy cm (non-synchronized) with p < 0.0001.

Conclusions

DS-CT is a highly sensitive method for LA thrombus detection in patients undergoing AF ablation. It delivers additional anatomic details of pulmonary veins and LA anatomy with an acceptable radiation exposure. Non-ECG-synchronized DS-CT showed a significantly lower radiation exposure, whereas diagnostic accuracy was comparable. Therefore, DS-CT might serve as primary method to exclude LA TF in patients undergoing AF ablation.

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Author notes

  1. Marc Kottmaier and Clemens Jilek contributed equally to this article.

Authors and Affiliations

  1. Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, 80636, Munich, Germany

    Marc Kottmaier, Clemens Jilek, Sophie Berglar, Tilko Reents, Felix Bourier, Verena Semmler, Martha Telishevska, Katharina Koch-Büttner, Sarah Lengauer, Marielouise Kornmayer, Elena Rousseva, Stephanie Brooks, Martin Hadamitzky, Christoph Kolb, Gabriele Hessling & Isabel Deisenhofer

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  1. Marc Kottmaier
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Correspondence to Marc Kottmaier.

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Kottmaier, M., Jilek, C., Berglar, S. et al. Exclusion of left atrial thrombus by dual-source cardiac computed tomography prior to catheter ablation for atrial fibrillation. Clin Res Cardiol 108, 150–156 (2019). https://doi.org/10.1007/s00392-018-1333-0

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  • DOI: https://doi.org/10.1007/s00392-018-1333-0

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