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Updated: Feb 4, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Real-time surveillance of left atrial appendage thrombus during contrast computed tomography imaging for catheter
Tetsuma Kawaji1, Hitomi Numamoto2, Shintaro Yamagami3
1Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan. kawaji@kuhp.kyoto-u.ac.jp.
Insights
A new real-time approach using left atrial contrast computed tomography (LA-CT) significantly improves the detection of left atrial appendage filling defects. This method enhances diagnostic accuracy, potentially offering superiority over transesophageal echocardiography for excluding left atrial appendage thrombus.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Left atrial contrast computed tomography (LA-CT) and transesophageal echocardiography (TEE) are used to detect left atrial appendage (LAA) thrombus.
- Incomplete LAA filling can limit the diagnostic accuracy of LA-CT.
- Real-time surveillance of LAA filling defects (FD) may improve LA-CT utility.
Purpose of the Study:
- To validate the utility of a real-time approach for LA-CT with real-time surveillance of LAA-FD.
- To compare the diagnostic accuracy of a novel LA-CT protocol with real-time surveillance against a conventional protocol.
Main Methods:
- A consecutive cohort of 894 patients undergoing LA-CT for catheter ablation was analyzed.
- Patients were divided into a conventional protocol group (N=474) and a novel protocol group with real-time LAA-FD surveillance and optional delayed scanning (N=420).
- LAA-FD severity was graded: Grade-0 (complete filling), Grade-1 (incomplete filling), and Grade-2 (complete defect).
Main Results:
- The novel protocol significantly reduced the prevalence of LAA-FD (Grade-1 and Grade-2) compared to the conventional protocol (1.0% vs. 28.5%).
- No Grade-2 FD was observed in the novel protocol group after additional scanning.
- The novel approach improved diagnostic accuracy, correctly identifying LAA status in cases where TEE suggested thrombus but LA-CT with real-time surveillance showed an intact LAA.
Conclusions:
- Real-time surveillance during LA-CT enhances the detection and characterization of LAA-FD.
- This novel LA-CT approach demonstrates improved diagnostic accuracy for excluding LAA thrombus compared to conventional methods.
- LA-CT with real-time surveillance shows potential superiority over TEE in excluding LAA thrombus.
Abstract:
Left atrial contrast computed tomography (LA-CT) as well as transesophageal echocardiography (TEE) can exclude left atrial appendage (LAA) thrombus, but is sometimes unable to evaluate LAA due to incomplete LAA filling. The aim of the current study was to validate the utility of real-time approach of LA-CT with real-time surveillance of LAA-filling defect (FD). We enrolled consecutive 894 patients with LA-CT studies acquired for catheter ablation and compared the diagnostic accuracy in demonstrating LAA-FD between conventional protocol (N = 474) and novel protocol with real-time surveillance of LAA-FD immediately after the initial scanning and, when necessary, adding delayed scanning in the supine or prone position (N = 420). Primary endpoint was severity of LAA-FD classified into the 3 groups: "Grade-0" for complete filling of contrast, "Grade-1" for incomplete filling of contrast, and "Grade-2" for complete FD of contrast. The prevalence of Grade-1 and Grade-2 FD was 17.3% and 11.2% in conventional protocol, whereas there was no patient with Grade-2 FD, and only 1 patient with Grade-1 FD after the additional scanning in novel protocol. In 5 patients with suspected LAA thrombus both by TEE and Grade-2 FD in LA-CT by the conventional protocol, ablation procedure was canceled due to diagnosis of LAA thrombus. Conversely, 4 patients with suspected LAA thrombus by TEE in novel protocol group was proved to have intact LAA by LA-CT with and without additional scanning. This novel approach with real-time surveillance improved the diagnostic accuracy of LA-CT in detecting LAA-FD, suggesting potential superiority of LA-CT over TEE in excluding LAA thrombus.
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