Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: Role of transesophageal echocardiography and multidetector computed tomography

Split-Bolus Single-Phase Cardiac Multidetector Computed Tomography for Reliable Detection of Left Atrial Thrombus: Comparison to Transesophageal Echocardiography

“…An LA size of 45 mm evaluated at a 75 % RR interval in MDCT and CHADS2 score ≥ 2 were shown to be independent risk factors for LA/LAA thrombus in our study which is in concordance with the published literature [17,18]. Apart from LA size and CHADS2 score, Dorenkamp et al identified the presence of diabetes mellitus as a single independent risk factor of LAA thrombus [18]. In this context, all 5 thrombi identified by MDCT in our study were found in patients with a CHADS2 score of ≥ 2 in combination with diabetes mellitus.…”

“…As previously mentioned, it is common to use the CHADS2 score to validate for estimating the risk of cerebral thromboembolic stroke in patients with AF [5,26]. An LA size of 45 mm evaluated at a 75 % RR interval in MDCT and CHADS2 score ≥ 2 were shown to be independent risk factors for LA/LAA thrombus in our study which is in concordance with the published literature [17,18]. Apart from LA size and CHADS2 score, Dorenkamp et al identified the presence of diabetes mellitus as a single independent risk factor of LAA thrombus [18].…”

“…In many centers MDCT prior to PVI is usually performed to define the exact anatomy and dimensions of the LA and the insertions of the pulmonary veins. Within the same scan MDCT imaging is also used to rule out LA/LAA thrombus formation [17,18]. Various study protocols for the detection of LA/LAA thrombus have been described and discussed in the past decade [9, 10, 17, 19 -26].…”

“…Usually nonionic iodinated contrast agent is used in a singlebolus injection with monophasic or biphasic CT protocols [9 -12, 17, 27]. It still remains a major limitation of MDCT that incomplete contrast filling of the LAA is the most frequent cause of false-positive thrombus formation in the LAA, leading to a low specificity and a low PPV of about 30 % [17,18,24].…”

Left atrial appendage thrombi relate to easily accessible clinical parameters in patients undergoing atrial fibrillation transcatheter ablation: A multicenter study

“…patients undergo TEE prior to AF ablation, without major significant regional differences 13 . 15 Our study included a selected population of patients without major structural 16 cardiomyopathies undergoing AF ablation and is, to the best of our knowledge, the largest available 17 series assessing this issue. Despite the strict selection criteria, the population included in our study is 18 well representative of a relevant share of subjects undergoing AF ablation in European centers in the 19 time span considered for our analysis 13 .…”