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Journal of Thrombosis and Thrombolysis

, Volume 47, Issue 1, pp 42–50 | Cite as

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

  • Tetsuma KawajiEmail author
  • Hitomi Numamoto
  • Shintaro Yamagami
  • Ryu Mabuchi
  • Takaaki Kitamura
  • Naomi Enoki
  • Koji Koizumi
  • Shotaro Kanao
  • Masashi Kato
  • Takafumi Yokomatsu
  • Satoshi Shizuta
  • Shinji Miki
  • Koh Ono
  • Kaori Togashi
  • Takeshi Kimura
Article

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.

Keywords

Atrial fibrillation Filling defect Left atrial appendage Thrombus Contrast computed tomography 

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

Notes

Acknowledgements

We appreciated all the members of the CT room in Graduate school of cardiovascular medicine, Kyoto University for their contribution to this study.

Compliance with ethical standards

Conflict of interest

No conflict of disclosures.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11239_2018_1742_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tetsuma Kawaji
    • 1
    Email author
  • Hitomi Numamoto
    • 2
  • Shintaro Yamagami
    • 3
  • Ryu Mabuchi
    • 2
  • Takaaki Kitamura
    • 2
  • Naomi Enoki
    • 2
  • Koji Koizumi
    • 2
  • Shotaro Kanao
    • 4
  • Masashi Kato
    • 1
  • Takafumi Yokomatsu
    • 1
  • Satoshi Shizuta
    • 1
  • Shinji Miki
    • 1
  • Koh Ono
    • 3
  • Kaori Togashi
    • 4
  • Takeshi Kimura
    • 3
  1. 1.Department of CardiologyMitsubishi Kyoto HospitalKyotoJapan
  2. 2.Division of Clinical Radiology Service, Graduate School of MedicineKyoto UniversityKyotoJapan
  3. 3.Department of Cardiovascular Medicine, Graduate School of MedicineKyoto UniversityKyotoJapan
  4. 4.Department of Radiology, Graduate School of MedicineKyoto UniversityKyotoJapan

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