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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a

Jorge Romero1, Syed Arman Husain, Iosif Kelesidis

  • 1Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467-2400, USA.

Circulation. Cardiovascular Imaging
|February 15, 2013
PubMed

Insights

Cardiac computed tomography (CT) is a reliable alternative to transesophageal echocardiogram (TEE) for detecting left atrial/appendage thrombi. Delayed imaging with cardiac CT significantly improves accuracy, offering a safer option than TEE.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Transesophageal echocardiogram (TEE) is the gold standard for detecting left atrial/appendage (LA/LAA) thrombi.
  • TEE is semi-invasive and carries rare but serious complications.
  • Cardiac computed tomography (CT) has emerged as a potential alternative imaging modality.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of cardiac CT for LA/LAA thrombi detection.
  • To compare cardiac CT efficacy against the gold standard TEE.
  • To assess the role of delayed imaging in improving cardiac CT accuracy.

Main Methods:

  • Systematic review and meta-analysis of Medline, Cochrane, and Embase databases.
  • Inclusion of 19 studies with 2955 patients diagnosed with atrial fibrillation or after cardioembolic stroke.
  • Analysis using standard approach and bivariate analysis, with a subanalysis for delayed imaging protocols.

Main Results:

  • Overall diagnostic accuracy of cardiac CT was 94% (sensitivity 96%, specificity 92%).
  • In studies with delayed imaging, accuracy improved to 99% (sensitivity 100%, specificity 99%).
  • Delayed imaging significantly enhanced positive predictive value (92%) and negative predictive value (100%).

Conclusions:

  • Cardiac CT is a reliable alternative to TEE for detecting LA/LAA thrombi.
  • Delayed imaging protocols enhance the diagnostic performance of cardiac CT.
  • Cardiac CT offers a safer, less invasive option for LA/LAA thrombi assessment.
Abstract

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