Utility of Nongated Multidetector Computed Tomography for Detection of Left Atrial Thrombus in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Abstract

In patients referred for CAAF, MDCT is a sensitive (100% sensitivity) imaging modality that could be used alone especially in patients age <52 years with a CHADS(2) score <1. Incorporation of these findings could decrease the need for multiple imaging modalities and thereby reduce cost of the procedure.

Association Between Left Atrial Appendage Morphology Evaluated by Trans-Esophageal Echocardiography and Ischemic Cerebral Stroke in Patients With Atrial Fibrillation

“…3,4) As the LAA represents one of the major sources of cardiac thrombus formation responsible for stroke in patients with AF, 5,6) the imaging of the different structures and lobes is of utmost importance to diagnose the presence of thrombus, especially in patients with non-valvular AF. 7,8) Multidetector computed tomography 9) and contrast-enhanced magnetic resonance imaging 10) are able to image the LAA; however, it was concluded that magnetic resonance imaging lacks diagnostic accuracy for the detection of LAA thrombi. 10) Transesophageal echocardiography (TEE) is the gold standard to detect LAA thrombus, 11) but false positive results still occur.…”

CT Imaging to Assess the Left Atrial Appendage Anatomy: Clinical Implications

“…CT identified LAA filling defects with a sensitivity, specificity, positive and negative predictive values of 93%, 85%, 31% and 99% respectively, as compared to TEE (Kim et al, 2007). These results have been recently confirmed by Martinez et al in a cohort of 402 patients (Martinez et al, 2009). Overall, 362 patients (91%) had no evidence of a filling defect by CT or left atrial spontaneous echo contrast or thrombus by transesophageal echocardiography.…”

Atrial thrombi detection prior to pulmonary vein isolation: Diagnostic accuracy of cardiac computed tomography versus transesophageal echocardiography

“…Current literature includes both prospective and retrospective cross-sectional studies, and a meta-analysis [5,[7][8][9][10][11][12][13]18]. Study sizes have varied from 72 to 402 patients [7,9], yet current literature remains controversial.…”

“…Study sizes have varied from 72 to 402 patients [7,9], yet current literature remains controversial. Martinez et al [9] found sensitivity and specificity of CCT to be 100% and 92%, respectively concluding that TEE is unnecessary. Similarly, Hur et al [13] found a sensitivity and specificity of 89% and 100%.…”

“…Although it has been demonstrated that CCT can also effectively rule out intracardiac thrombi [6], studies are small and results have been inconsistent in findings and methodology [5,[7][8][9][10][11][12][13][14]. For instance, the largest study on the subject by Martinez et al [9], reached the conclusion that CCT is sensitive enough to warrant the use of only CCT to rule out atrial thrombi, but this conclusion has been called into question for sub-optimal study methodology [15]. Variations in prospective and retrospective electrocardiogram (ECG-gating), patient positioning, and length of time between CCT and TEE are factors that have been inconsistent across studies.…”