Into the new dawn or back to the roots!? Is cardiac computed tomography the future for thrombus exclusion in the left atrial appendage?

2021 ◽  
Author(s):  
Andreas Metzner ◽  
Andreas Rillig ◽  
Christoph Sinning
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Atrial Appendage ◽  
The Future

Intraprocedural Hybrid Cardiac Computed Tomography for Left Atrial Appendage Occlusion

2021 ◽  
Vol 14 (16) ◽  
pp. 1852-1853
Author(s):  
Mahdi Veillet-Chowdhury ◽  
Stewart M. Benton ◽  
C. Anwar A. Chahal ◽  
James E. Harvey ◽  
Paul Tolerico ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion

scholarly journals Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement

2020 ◽  
Vol 47 (2) ◽  
pp. 78-85
Author(s):  
Kazuhiro Osawa ◽  
Rine Nakanishi ◽  
Indre Ceponiene ◽  
Negin Nezarat ◽  
William J. French ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Left Atrial Volume ◽  
Atrial Appendage ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Appendage Thrombus

Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03–1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05–1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.

scholarly journals Predictors of Spontaneous Echocardiographic Contrast Within the Left Atrial Appendage in Cardiac Computed Tomography of Patients with Atrial Fibrillation

2021 ◽  
Author(s):  
Kotaro Ouchi ◽  
Toru Sakuma ◽  
Takahiro Higuchi ◽  
Jun Yoshida ◽  
Ryosuke Narui ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cardiac Ct ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Atrial Appendage ◽  
Receiver Operator Characteristic

Abstract PurposeCardiac computed tomography (CT) depiction of the relationship between spontaneous echocardiographic contrast (SEC) and findings of the left atrial appendage (LAA) has not been reported. We evaluated predictors of SEC within the LAA using findings of cardiac CT in patients with atrial fibrillation (AF).MethodsWe retrospectively analyzed cardiac CT findings of the LAA, including morphology, volume, and filling defects, of 641 patients who underwent Transesophageal echocardiography (TEE) prior to pulmonary vein isolation (PVI) from January 6, 2013 through December 16, 2019 at our institution. We investigated potential associated factors that might be predictors of SEC and computed a receiver operator characteristic,choosing a threshold value at which the likelihood of SEC could be predicted based on the LAA volume indexed for body size.ResultsSEC correlated significantly with history of persistent AF (P<0.001; odds ratio [OR], 3.74; 95% confidence interval [CI], 1.91–7.29), LAA early filling defects (P =0.003; OR, 2.83; 95% CI, 1.43–5.62), LAAFV (P<0.001; OR, 0.97; 95% CI, 0.96–0.99), and indexed LAA volume (P = 0.001; OR, 1.18; 95% CI, 1.07–1.30) of 8.04 cm3/m2 or greater (sensitivity, 75.0%; specificity, 48.7%).The addition of LAAFV to indexed LAA volume increased the area under the receiver operator characteristic curve from 0.642 to 0.724 (P< 0.001).ConclusionFindings of LAA in cardiac CT might allow the noninvasive estimation of SEC and additional information for risk stratification and management of thromboembolic events in patients with AF.

scholarly journals Transition from Transesophageal Echocardiography to Cardiac Computed Tomography for the Evaluation of Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation and Incidence of Cerebrovascular Events During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Tauseef Akhtar ◽  
Ryan Wallace ◽  
Usama Daimee ◽  
Erica Hart ◽  
Armin Arbab-Zadeh ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Ct Imaging ◽  
Atrial Appendage ◽  
Af Ablation ◽  
Cerebrovascular Events

Background Transesophageal echocardiography (TEE) is variably performed before atrial fibrillation (AF) ablation to evaluate left atrial appendage (LAA) thrombus. We describe our experience with transitioning to the pre-ablation cardiac computed tomography (CT) approach for the assessment of LAA thrombus during the COVID-19 pandemic. Methods We studied consecutive patients undergoing AF ablation at our center. The study cohort was divided into pre- vs. post-COVID groups. The pre-COVID cohort included ablations performed during 1 year before the COVID-19 pandemic; pre-ablation TEE was used routinely to evaluate LAA thrombus in high-risk patients. Post-COVID cohort included ablations performed during the 1 year after the COVID-19 pandemic; pre-ablation CT was performed in all patients, with TEE performed only in patients with LAA thrombus by CT imaging. The demographics, clinical history, imaging, and ablation characteristics, and peri-procedural cerebrovascular events (CVE) were recorded. Results A total of 637 patients (pre-COVID n=424, post-COVID n=213) were studied. The mean age was 65.6  10.1 years in the total cohort, and the majority were men. There was a significant increase in pre-ablation CT imaging from pre to post-COVID cohort (74.8 vs. 93.9%, p=<0.01), with a significant reduction in TEEs (34.6 vs. 3.7%, p=<0.01). One patient in the post-COVID cohort developed CVE following negative pre-ablation CT. However, the incidence of peri-procedural CVE between both cohorts remained statistically unchanged (0 vs. 0.4%, p=0.33). Conclusion Implementation of pre ablation CT-only imaging strategy with selective use of TEE for LAA thrombus evaluation is not associated with increased CVE risk during the COVID- 19 pandemic.

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