Abstract
Left atrial contrast computed tomography (LA-CT) as well as transesophageal echocardiography (TEE) can exclude left atrial appendage (LAA) thrombus, but is sometimes unable to evaluate LAA due to incomplete LAA filling. The aim of the current study was to validate the utility of real-time approach of LA-CT with real-time surveillance of LAA-filling defect (FD). We enrolled consecutive 894 patients with LA-CT studies acquired for catheter ablation and compared the diagnostic accuracy in demonstrating LAA-FD between conventional protocol (N = 474) and novel protocol with real-time surveillance of LAA-FD immediately after the initial scanning and, when necessary, adding delayed scanning in the supine or prone position (N = 420). Primary endpoint was severity of LAA-FD classified into the 3 groups: “Grade-0” for complete filling of contrast, “Grade-1” for incomplete filling of contrast, and “Grade-2” for complete FD of contrast. The prevalence of Grade-1 and Grade-2 FD was 17.3% and 11.2% in conventional protocol, whereas there was no patient with Grade-2 FD, and only 1 patient with Grade-1 FD after the additional scanning in novel protocol. In 5 patients with suspected LAA thrombus both by TEE and Grade-2 FD in LA-CT by the conventional protocol, ablation procedure was canceled due to diagnosis of LAA thrombus. Conversely, 4 patients with suspected LAA thrombus by TEE in novel protocol group was proved to have intact LAA by LA-CT with and without additional scanning. This novel approach with real-time surveillance improved the diagnostic accuracy of LA-CT in detecting LAA-FD, suggesting potential superiority of LA-CT over TEE in excluding LAA thrombus.
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Abbreviations
- AF:
-
Atrial fibrillation
- CT:
-
Computed tomography
- FD:
-
Filling defect
- LA:
-
Left atrium
- LAA:
-
Left atrial appendage
- LA-CT:
-
Left atrial contrast computed tomography
- MRI:
-
Magnetic resonance imaging
- PVI:
-
Pulmonary veins isolation
- SEC:
-
Spontaneous echo contrast
- TEE:
-
Transesophageal echocardiography
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Acknowledgements
We appreciated all the members of the CT room in Graduate school of cardiovascular medicine, Kyoto University for their contribution to this study.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Kawaji, T., Numamoto, H., Yamagami, S. et al. Real-time surveillance of left atrial appendage thrombus during contrast computed tomography imaging for catheter ablation: THe Reliability of cOMputed tomography Beyond UltraSound in THROMBUS detection (THROMBUS) study. J Thromb Thrombolysis 47, 42–50 (2019). https://doi.org/10.1007/s11239-018-1742-y
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DOI: https://doi.org/10.1007/s11239-018-1742-y