European Radiology

, Volume 28, Issue 5, pp 1835–1843 | Cite as

Transoesophageal echocardiography prior to catheter ablation could be avoided in atrial fibrillation patients with a low risk of stroke and without filling defects in the late-phase MDCT scan: A retrospective analysis of 783 patients

  • Zhengqin Zhai
  • Min TangEmail author
  • Shu Zhang
  • Pihua Fang
  • Yuhe Jia
  • Tianjie Feng
  • Jiande Wang
Computed Tomography



To test whether multidetector computed tomography (MDCT) could completely replace transoesophageal echocardiography (TEE) to detect left atrial appendage (LAA) thrombi in atrial fibrillation (AF) patients using a large sample size.


783 patients with AF who underwent MDCT and TEE before catheter ablation were retrospectively included. Demographic data were obtained. Two radiologists blinded to clinical data made the imaging diagnosis.


Most of the patients (96.2 %) had a CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥ 75 years old (doubled), diabetes, stroke/transient ischaemic attack/thromboembolism (doubled), vascular disease, age 65–74 years, female sex) ≤ 3. Eight thrombi were identified by TEE, all of which were detected by MDCT; no thrombus was observed with TEE without the observation of filling defects by late-phase MDCT scanning in any of the patients. Using TEE as reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of MDCT for thrombus detection were 100 %, 95.74 % (95 % CI 94.33 %–97.15 %), 19.51 % (95 % CI 16.73 %–22.29 %) and 100 %, respectively.


For AF patients with low risk of stroke, when MDCT images showed no filling defect in the late phase, TEE prior to catheter ablation can be avoided.

Key Points

MDCT can help detect the presence of LAA thrombus.

TEE can be avoided when late-phase MDCT shows no filling defect.

TEE is required in patients whose MDCT images indicate thrombus.


Multi-detector computed tomography Transoesophageal echocardiography Left atrial appendage Thrombus Atrial fibrillation 

Abbreviations and acronyms


Atrial fibrillation


Catheter ablation


Congestive heart failure, hypertension, age ≥ 75 years (doubled), diabetes previous stroke/transient ischaemic attack/thromboembolism (doubled), vascular disease, age 65–74 years, and sex category (female)


Congestive heart failure


Left atrial appendage


Left atrial dimension


Left ventricular end-diastolic dimension


Left ventricular ejection fraction


Multidetector computed tomography


Spontaneous echo contrast


Transoesophageal echocardiography


Transient ischaemic attack


Vascular diseases



The authors thank Lei Han for MDCT consulting services.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Min Tang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Zhengqin Zhai
    • 1
  • Min Tang
    • 1
    Email author
  • Shu Zhang
    • 1
  • Pihua Fang
    • 1
  • Yuhe Jia
    • 1
  • Tianjie Feng
    • 1
  • Jiande Wang
    • 1
  1. 1.Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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