Key result
Cardiac CT accurately excludes left atrial appendage thrombus as a noninvasive alternative to TEE before AF ablation.
Why the study?
Pre-procedural exclusion of LAA thrombosis is necessary before AF intervention, and advanced imaging modalities like computed tomography and magnetic resonance tomography are growing in clinical importance.
Does tomographic visualization improve the pre-procedural diagnostic algorithm for excluding left atrial appendage thrombosis in patients with atrial fibrillation?
Does tomographic visualization improve the pre-procedural diagnostic algorithm for excluding left atrial appendage thrombosis in patients with atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Computed tomography is a highly accurate, non-invasive imaging modality that can reduce the need for transesophageal echocardiography when screening for left atrial appendage thrombus before atrial fibrillation ablation.
Due to intracardiac circulatory changes atrial fibrillation creates conditions for thrombus formation in the left atrial appendage (LAA). The presence of thrombus in LAA is poor prognostic factor of subsequent cardiovascular events. It is the source of up to 64% of ischemic stroke cases, and concomitant anticoagulant therapy leads to a high frequency of hemorrhagic conversion. For patient with symptomatic and drug-refractory arrhythmia is recommended surgical rhythm correction or electrical cardioversion. There is a high risk of cardioembolic stroke during the intervention, so it is necessary to exclude LAA thrombosis at pre-operation stage. The main method of LAA visualization is transesophageal echocardiography, but today computed tomography and, less, magnetic resonance tomography become important. The purpose of this review is to analyze the possibilities of each visualisation technique and their role in the diagnostic algorithm when examining patients before catheter ablation of atrial fibrillation sources.
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Kashtanova et al. (2020) conducted a review in Atrial fibrillation. Left atrial appendage computed tomography vs. Transesophageal echocardiography was evaluated. Computed tomography provides a non-invasive and highly sensitive alternative to transesophageal echocardiography for excluding left atrial appendage thrombosis prior to atrial fibrillation ablation.
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