Identification of left atrial appendage thrombi in patients with persistent and long-standing persistent atrial fibrillation using intra-cardiac echocardiography and cardiac computed tomography

Yukinori Ikegami, Kojiro Tanimoto, Kohei Inagawa, Yasuyuki Shiraishi, Jun Fuse, Munehisa Sakamoto, Yukihiko Momiyama, Seiji Takatsuki

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Intracardiac echocardiography (ICE) and cardiac computed tomography (CCT), in addition to standard transesophageal echocardiography (TEE), have been used to identify left atrial (LA) thrombi prior to ablation for atrial fibrillation (AF). The clinical advantages of this, however, remain unclear. This study therefore investigated the advantages of additional pre-procedural LA appendage (LAA) thrombus evaluation using ICE and the clinical value of CCT in persistent and long-standing persistent AF. Methods and Results: We analyzed data from 108 consecutive patients with persistent and long-standing persistent AF who were scheduled to undergo AF ablation. TEE was performed within 24 h prior to ablation. ICE was performed for 97 patients in whom a thrombus was not detected on TEE. CCT was performed in 95 patients. Thrombus or sludge was detected on TEE in 11 patients (10.3%), for whom ablation was cancelled. Four additional patients were diagnosed with LAA thrombus on ICE. When TEE and ICE were used as the reference for thrombus detection, the sensitivity, specificity, positive predictive value, and negative predictive value of CCT for identifying contrast defects in the LAA were 100%, 81.0%, 40.7%, and 100%, respectively. Conclusions: ICE combined with TEE increased the detection rate of LAA thrombi in patients with persistent and long-standing persistent AF. Moreover, CCT had high sensitivity and negative predictive value for LAA thrombus detection.

Original languageEnglish
Pages (from-to)46-52
Number of pages7
JournalCirculation Journal
Volume82
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

    Fingerprint

Keywords

  • Cardiac computed tomography
  • Intracardiac echocardiography
  • Left atrial thrombus
  • Persistent atrial fibrillation
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this