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Updated: Jun 5, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Different scanning protocol to assess left atrial appendage thrombus in patients with atrial fibrillation by
Chunjuan Sun1, Junwei Lv1, Ming Liu2
1Department of Radiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai, 264000, Shandong, China.
Insights
Cardiovascular Computed Tomography (CCT) effectively rules out left atrial appendage (LAA) thrombus in atrial fibrillation (AF) patients. This imaging technique offers high accuracy, potentially replacing transesophageal echocardiography in select cases.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Atrial fibrillation (AF) increases the risk of left atrial appendage (LAA) thrombus formation.
- Accurate thrombus detection is crucial for guiding anticoagulation therapy and preventing thromboembolic events.
Purpose of the Study:
- To evaluate the efficacy of Cardiovascular Computed Tomography (CCT) using various protocols for ruling out LAA thrombus in AF patients.
- To compare CCT findings with intraoperative results and transesophageal echocardiography (TEE) for thrombus detection.
Main Methods:
- Retrospective review of CCT images from 138 AF patients.
- Intraoperative findings served as the reference standard for cases without diagnosed thrombus on CCT.
- TEE examination was used for comparison in patients with diagnosed thrombi on CCT.
Main Results:
- CCT demonstrated 100% accuracy in confirming the absence of LAA thrombus in 126 patients.
- CCT detected 12 thrombi, while TEE identified 11; only one discrepancy between the two methods was noted.
- Different CCT scanning protocols were utilized based on individual patient characteristics.
Conclusions:
- CCT is a highly accurate method for ruling out LAA thrombus in AF patients.
- Tailored CCT protocols can effectively assess LAA thrombus, offering a potential alternative to TEE in specific clinical scenarios.
Abstract:
To investigate whether we can rule out the left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) using different scanning protocol by Cardiovascular Computed Tomography (CCT). We retrospectively reviewed the CCT images of 138 patients with AF to assess LAA thrombus. Patients with no thrombosis diagnosed by preoperative CCT should be confirmed using intraoperative findings as the reference standard. Patients diagnosed with thrombosis were then compared with TEE examination. Different CT scanning protocol were used to assess LAA thrombus according to individual differences. In 126 cases, there was no thrombus in the LAA evaluated by preoperative CCT, and it was confirmed in the subsequent radiofrequency operation. CCT has the accuracy of 100% in confirming the absence of thrombus in the LAA. Twelve thrombi were detected by CCT, eleven thrombi were detected by TEE. Only one patient had different results between CCT and TEE. We could use different CT scanning protocol to rule out LAA thrombus according to individual differences. In some special patients, LAA thrombus can be evaluated by CCT instead of TEE.
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