Related Experiment Video
Updated: Mar 13, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
CTA Detection of Left Atrial Stasis and Thrombus in Patients with Atrial Fibrillation
Lin Wang1, Madhavi Kadiyala1, Elana Koss1
1St. Francis Hospital, The Heart Center, Roslyn, New York.
Insights
Computed tomography angiography (CTA) can accurately assess left atrial appendage (LAA) thrombus in atrial fibrillation (AF) patients. Negative CTA findings reliably rule out LAA stasis or thrombus, potentially eliminating the need for transesophageal echocardiography (TEE).
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Atrial fibrillation (AF) ablation requires preprocedural assessment of left atrial appendage (LAA) stasis and thrombus.
- Transesophageal echocardiography (TEE) is the standard for this evaluation, but it is invasive.
Purpose of the Study:
- To investigate the utility of computed tomography angiography (CTA) in evaluating LAA stasis and thrombus in AF patients.
- To determine if CTA can replace TEE in preprocedural AF ablation planning.
Main Methods:
- Retrospective review of CTA and TEE images from 861 AF patients undergoing preablation assessment.
- Comparison of CTA findings (filling defects) with TEE findings (stasis grade, thrombus presence, and LAA flow velocity).
Main Results:
- CTA had a low positive predictive value (13%) for thrombus or significant stasis.
- CTA demonstrated a high negative predictive value (99.9%) for thrombus or significant stasis.
- Slow LAA Doppler flow velocity was the primary determinant of false-positive CTA results.
Conclusions:
- Negative CTA findings reliably exclude significant LAA stasis and thrombus.
- CTA may enable the elimination of TEE in up to 80% of AF ablation patients.
- CTA is a valuable tool for preprocedural risk stratification in AF ablation.
Background:
We investigated computed tomography (CT) angiography (CTA) in assessment of left atrial appendage (LAA) stasis and thrombus in preprocedural evaluation for atrial fibrillation (AF) ablation in a large community cohort.
Methods And Results:
We reviewed CTA and transesophageal echocardiographic images obtained in 861 consecutive patients with a history of AF undergoing same-day CTA and transesophageal echocardiogram (TEE) before AF ablation at a single hospital (2006-2013). CTA findings of LAA filling defects from acquisitions without electrocardiogram gating were compared to TEE features of LAA stasis (grade 0-4) and thrombus. Stasis grade 0 or 1 by TEE in the absence of thrombus was defined as a negative result. In addition, LAA peak flow velocity was assessed by TEE. Average age was 61 ± 10 years and 75% were male. On CTA, 161 patients (19%) had LAA filling defects on CTA and 21 had ≥grade 2 stasis on TEE, including two with thrombus, resulting in a positive predictive value of only 13%. However, among 670 CTA-negative patients, 669 (99%) were negative for thrombus or stasis by TEE with one false-negative CTA in a patient with grade 2 stasis by TEE but no thrombus, yielding a negative predictive value of 99.9%. Slow LAA Doppler flow velocity was the most important determinant of false-positive CTA results in multivariate analysis (P < 0.0001) CONCLUSION: LAA filling defects on CT are associated with slow LAA flow velocity. AF patients without LAA filing defects on CT are free of significant stasis and thrombus on TEE. It may be possible to eliminate TEE in up to 80% of AF ablation patients based on negative CTA findings.
Related Concept Videos
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:24Cardiac Catheterization III: Left Heart Catheterization
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies