What does this research mean for the field?

Patients with paroxysmal atrial fibrillation and normal ejection fraction presenting for pulmonary vein antrum isolation have a zero incidence of left atrial appendage thrombus, suggesting that prescreening with CT alone is sufficient and routine transesophageal echocardiography may be unnecessary. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 13, 2008Journal of Cardiovascular Electrophysiology

Low Incidence of Left Atrial or Left Atrial Appendage Thrombus in Patients with Paroxysmal Atrial Fibrillation and Normal EF Who Present for Pulmonary Vein Antrum Isolation Procedure

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Paroxysmal atrial fibrillation (n=1221). Intervention: Computed tomography (CT) screening vs. Transesophageal echocardiography (TEE). Primary outcome: Incidence of left atrial appendage (LAA) thrombus.

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Key result

Among 1,221 patients undergoing pulmonary vein antrum isolation, 0 patients with paroxysmal atrial fibrillation and normal ejection fraction had left atrial appendage thrombus.

Why the study?

Does computed tomography adequately screen for left atrial appendage thrombus in patients with paroxysmal atrial fibrillation and normal ejection fraction presenting for pulmonary vein antrum isolation?

Population

1,221 consecutive patients who underwent a pulmonary vein antrum isolation procedure from January 2000 to…

Design

Cohort

Follow-up

3 months post-PVAI

Authors

MKMohammed KhanInstitute of Medical Sciences AUAli UsmaniCOMSATS University Islamabad SNSaira NoorUniversity of Baghdad

Discussion

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Implication

May support CT-only LAA screening without routine TEE in paroxysmal AF with normal EF; leaves open prospective validation.

Key Points

This research aims to determine the incidence of left atrial appendage thrombus in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation.
Prospective evaluation of patients who underwent pulmonary vein antrum isolation from January 2000 to June 2004.
Computed tomography was performed to assess left atrial appendage thrombus before and at 3 months post-procedure.
Transesophageal echocardiography was conducted for patients with positive CT scans.
Only 3 out of 1221 patients had left atrial thrombus confirmed by TEE before pulmonary vein isolation.
No patients with paroxysmal atrial fibrillation and normal ejection fraction had left atrial thrombus.
Patients with left atrial thrombus had significantly lower ejection fractions (40% vs. 53%, P = 0.007) compared to those without.

Study Design

Type

Cohort (n=1,221)

Structured PICO

Population

1,221 consecutive patients who underwent a pulmonary vein antrum isolation procedure (PVAI) from January 2000 to June 2004

Intervention

Computed tomography (CT) to evaluate left atrial appendage (LAA) thrombus before the procedure

Outcome

Incidence of left atrial appendage (LAA) thrombussurrogate

In patients with paroxysmal atrial fibrillation and normal ejection fraction undergoing PVAI, the incidence of LAA thrombus is zero, suggesting pre-procedural CT alone may be sufficient without routine TEE.

Cite This Study

Khan et al. (2008) conducted a cohort in Paroxysmal atrial fibrillation (n=1,221). Computed tomography (CT) screening vs. Transesophageal echocardiography (TEE) was evaluated on Incidence of left atrial appendage (LAA) thrombus. Among 1,221 patients undergoing pulmonary vein antrum isolation, 0 patients with paroxysmal atrial fibrillation and normal ejection fraction had left atrial appendage thrombus.

synapsesocial.com/papers/6a157ffeb2e0231f15829583 https://doi.org/10.1111/j.1540-8167.2007.01070.x

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Low Incidence of Left Atrial or Left Atrial Appendage Thrombus in Patients with Paroxysmal Atrial Fibrillation and Normal EF Who Present for Pulmonary Vein Antrum Isolation Procedure

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Low Incidence of Left Atrial or Left Atrial Appendage Thrombus in Patients with Paroxysmal Atrial Fibrillation and Normal EF Who Present for Pulmonary Vein Antrum Isolation Procedure

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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