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
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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.
• 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.
KeywordsMulti-detector computed tomography Transoesophageal echocardiography Left atrial appendage Thrombus Atrial fibrillation
Abbreviations and acronyms
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
Transient ischaemic attack
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• diagnostic study
• performed at one institution
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