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

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

doi:10.1007/s00392-018-1333-0

journal article

Document type:: Comparative Study; Journal Article
Author(s):: Kottmaier, Marc; Jilek, Clemens; Berglar, Sophie; Reents, Tilko; Bourier, Felix; Semmler, Verena; Telishevska, Martha; Koch-Büttner, Katharina; Lengauer, Sarah; Kornmayer, Marielouise; Rousseva, Elena; Brooks, Stephanie; Hadamitzky, Martin; Kolb, Christoph; Hessling, Gabriele; Deisenhofer, Isabel
Title:: Exclusion of left atrial thrombus by dual-source cardiac computed tomography prior to catheter ablation for atrial fibrillation.
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.
Journal title abbreviation:: Clin Res Cardiol
Year:: 2019
Journal volume:: 108
Journal issue:: 2
Pages contribution:: 150-156
Fulltext / DOI:: doi:10.1007/s00392-018-1333-0
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/30051177
Print-ISSN:: 1861-0684
TUM Institution:: Institut für Radiologie; Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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