Document Detail


Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation.
MedLine Citation:
PMID:  19356536     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to determine whether multidetector computed tomography (MDCT) is able to exclude left atrial appendage (LAA) thrombus in patients referred for catheter ablation of atrial fibrillation (CAAF). BACKGROUND: MDCT is commonly used to render pulmonary vein and left atrial anatomy before CAAF. Transesophageal echocardiography (TEE) is also often performed before the ablation to exclude LAA thrombus. Whether MDCT alone is sufficient to exclude LAA thrombus is unknown. METHODS: Patients referred for CAAF at the Mayo Clinic between March 2004 and October 2006 were included. Clinical data, 64-slice MDCT (nonelectrocardiography-gated), and TEE were all analyzed. Image data were independently reviewed by 2 cardiac radiologists blinded to the TEE findings. The appearance of the LAA was defined as normal (fully opacified) or abnormal (underfilled). RESULTS: Four hundred two patients (mean age 56 +/- 10 years; 76% male; ejection fraction 56 +/- 10%) were included. Three hundred sixty-two had no evidence of a filling defect by ungated MDCT or left atrial spontaneous echo contrast or thrombus by TEE. In 40 patients, the LAA was "underfilled" with 9 definite thrombi confirmed by TEE. Sensitivity and specificity was 100% and 92%, respectively, with a negative predictive value of 100% and positive predictive value of 23%. In patients with LAA underfilling, Doppler-derived LAA emptying velocities were substantially reduced (mean 19 cm/s; range 6 to 61 cm/s) below the normal range. A higher CHADS(2) (congestive heart failure, hypertension, age older than 75 years, and diabetes) score (1.6 vs. 1.1) was observed in patients with LAA filling defects. No cases of LAA thrombus were observed in patients age <52 years with CHADS(2) score <1. CONCLUSIONS: In patients referred for CAAF, MDCT is a sensitive (100% sensitivity) imaging modality that could be used alone especially in patients age <52 years with a CHADS(2) score <1. Incorporation of these findings could decrease the need for multiple imaging modalities and thereby reduce cost of the procedure.
Authors:
Matthew W Martinez; Jacobo Kirsch; Eric E Williamson; Imran S Syed; DaLi Feng; Steve Ommen; Douglas L Packer; Peter A Brady
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-07-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69-76     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Diseases, Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Atrial Appendage / radiography,  ultrasonography
Atrial Fibrillation / complications,  radiography,  surgery*,  ultrasonography
Catheter Ablation* / adverse effects
Echocardiography, Doppler*
Echocardiography, Transesophageal*
Female
Heart Diseases / etiology,  radiography*,  ultrasonography
Humans
Male
Middle Aged
Patient Selection
Predictive Value of Tests
Risk Assessment
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Thrombosis / etiology,  radiography*,  ultrasonography
Tomography, X-Ray Computed*
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2009 Jan;2(1):77-9   [PMID:  19356537 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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