Author + information
- Justues Chang,
- Sohaib Munir,
- Shafeequr Salahudeen,
- Adrian Baranchuk,
- Cheryl Morris,
- Michael O'Reilly and
- Raveen S. Pal
Pulmonary vein isolation (PVI) is a common treatment for patients with symptomatic atrial fibrillation. Cardiac computed tomography (CCT) is required prior to PVI to obtain a left atrium and pulmonary vein anatomical map on which to superimpose an electrical map. Patients also routinely undergo transesophageal echocardiography (TEE) to rule out presence of left atrial and left atrial appendage (LAA) thrombus. We sought to determine whether CCT alone is adequate to exclude the presence of LAA thrombus.
Patients who underwent PVI's during 2010 and 2011 were identified. Analysis was limited to patients with CCT and TEE within 3 days of each other. CHADS2 scores were calculated. LAA thrombus was identified by cardiologists trained in TEE, blind to CCT results CCT's were read by a cardiologist trained in CCT, who was blind to the TEE results.
51 patients had both TEE and CCT within a 3 day period (mean age 59.9 ± 9.6 years; 64% male; ejection fraction 60 ± 12%). By TEE, 0 LAA thrombi were identified. By CCT, 2 LAA thrombi were identified and 4 could not be ruled out. Specificity, positive predictive value and negative predictive value for CCT were 80.4%, 0%, and 100%, respectively. Due to lack of positive findings by TEE, CCT sensitivity was indeterminate.
These results demonstrate that CCT is an effective tool in ruling-out LAA thrombi prior to PVI (NPV=100%). We propose that TEE be reserved for those cases where CCT is positive, when TEE may still be able to rule out thrombus.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: CT/Multimodality IV
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1182-348
- 2013 American College of Cardiology Foundation