Use of Computed Tomography Scan to Rule Out Phantom Thrombus in the Left Atrial Appendage
Occurrence of left atrial appendage (LAA) thrombus is a frequent complication of atrial fibrillation (AF) and it increase thromboembolic risk. Transesophageal echocardiography (TEE) is considered the gold standard to ensure that this chamber is thrombus free. Multidetector computed tomography (CT) scan has some advantages such the possibility to get 3D reconstruction and explore another structures in relationship with the LAA. However, lack of specificity in case of false positive images with filling defects due to slow velocities in the LAA. Methods and Results: 34 patiens with suspected thrombus by a previous CT scan or transesophageal echo were included in analisys. The aim of study was evaluated the utility of CT scan with delayed acquisition protocol to exclude LAA thrombus. In all of patients, complete LAA filling was observed, with a sensitivity, specificity and negative predictive value of 100% to differentiate circulatory stasis from thrombus. Conclusion: Perform a CT scan with a delayed acquisition protocol and in prone position are safe techniques to rule out fake thrombus.
- CalkinsH, Kuck KH, Cappato R, et al. (2012) HRS/EHRA/ ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm 9(4):632M696
- Welch W. A System of Medicine. 2nd ed. Lon- don: MacMillan and Co, Ltd., 1909.
- Roy Beigel, MD, Nina C. Wunderlich, MD, Siew Yen Ho, MD, Reza Arsanjani, MD, Robert J. Siegel, MD . The Left Atrial Appendage: Anatomy, Function, and Noninvasive Evaluation . J Am Coll Cardiol Img 2014;7:1251–65
- Manning WJ, Weintraub RM, Waksmonsky CA et al. Accuracy of transesophageal echocardiography for identifying left atrial trhombi. A prospective, intraoperative study. Ann Intern Med 123 (11):817-822.
- Chan KL, Cohen GI, Sochowski RA, Baird MG. Complications of transesophageal echocardiography in ambulatory adult patients: analysis of 1500 consecutive examinations. J Am Soc Echocardiogr 4(6):577-582
- Daniel WG, Erbel R, Kas[er W et al. Safety of transesophageal echocardiography. A multicenter survey of 10419 examinations. Circulation 83 (3): 817-821
- Kallmeyer IJ, Collard CD, Fox JA, Body SC, Shernan SK. The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients. Anesth Analg 92(5):1126-1130.
- Min JK, Spencer KT, Furlong KT et al. Clinical features of complications from transesophageal echocardiography: a single center case series of 10000 consecutive examinations. J Am Soc Echocardiogr 18 (9): 925-929.
- Bilchick KC, Mealor A, Gonzalez J et al. Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusión into the care of patients undergoing ablation of atrial fibrilation. Heart Rhythm 13(1):12-19.
- Cas Teunissen. Jesse Habets· Bir itta K. Velthuis· Maarten J. Cramer· Peter Loh. Double-contrast, single-phase computed tomograph. angiograph. for ruling out left atrial appendage thrombus prior to atrial fibrillation ablation. Int J Cardiovasc Imaging (2017) 33:121–128
- Dorenkamp M, Sohns C, Vollmann D et al. Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: role of transesophageal echocardiography and multidetector computed tomography. Int J Cardiol 163(1):26-33.
- Tang RB, Dong JZ, Zhang ZQ et al. Comparison of contrast enhanced 64-slice computed tomography and transesophageal echocardiography in detection of left atrial trhombus in patients with atrial fibrillation. J Interven Cardiac Electrophysiol 22(3):199-203.
- Hur J, Kim YJ, Lee HJ et al. Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography. Stroke 42(9):2471-2477.
- Hur J, Kim YJ, Lee HJ et al. Cardioembolic stroke: dual energy cardiac CT for differentiation of left atrial apppendage trhombus and circulatory stasis. Radiology 263(3):688-695.
- Hur J, Kim YJ, Lee HJ et al. Cardiac computed tomographic angiography for detection of cardiac sources of embolism in stroke patients. Stroke 40(6):2073-2078.
- Hur J, Kim YJ, Lee HJ et al. Left atrial appendage thrombi in stroke patients: detection with two-phase cardiac CT angiography versus transesophageal echocardiography. Radiology 251(3):683-690.
- Kim SC, Chun EJ, Choi SI et al. Differentiation between spontaneous echocardiographic contrast and left atrial appendage thrombus in patients with suspected embolic stroke using two-phase multidetector computed tomography, Am J Cardiol 106(8):1174-1181.
- Sawit ST, Garcia-Alvarez A, Suri B et al. Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. Am J Cardiol 109(5):677-684.
-Kanae Hasegawa, Shinzune Miyazaki, Tomokazu Ishida et al. Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Japan. Computed tomography in the prone position is a simple and useful technique to differenciate left atrial appendage trhombi from circulatory stasis. HRS poster Session. May 2018.
- Hirotaka Muramoto, Koji Higuchi, Shinsuke Iwai et al. 1)Hiratsuka-Kyosai Hospital, Department of Cardiology, Kanagawa, Japan. 2) Hiratsuka-Kyosai Hospital, Department of Radiology. 3) Tokyo Medical and Dental University. Tokyo, Japan. HRS poster Session. May 2018.
- Kantarci M(1), Ogul H(1), Sade R(1), Aksakal E(2), Colak A(3),Tanboga IH. Circulatory Stasis or Thrombus in Left Atrial Appendage, An Easy Diagnostic Solution. J Comput Assist Tomogr. 2019 May/Jun;43(3):406-409.
- Kawaji T(1), Numamoto H(2), Yamagami S(3), Mabuchi R(2), Kitamura T(2), Enoki
N(2), Koizumi K(2), Kanao S(4), Kato M(5), Yokomatsu T(5), Shizuta S(5), Miki
S(5), Ono K(3), Togashi K(4), Kimura T(3). Real-time surveillance of left atrial appendage thrombus during contrast computed tomography imaging for catheter ablation: THe Reliability of cOMputed tomography Beyond UltraSound in THROMBUS detection (THROMBUS) study. J Thromb Thrombolysis. 2019 Jan;47(1):42-50.
- Matthew J. Budoff, MD, Adekunle Shittu, MD, Yalcin Hacioglu, MD, Eli Gang, MD, Dong Li, MD, PhD, Harpreet Bhatia, MD, Juan Alvergue, MD, and Ronald P. Karlsberg, MD. Comparison of Transesophageal Echocardiography Versus Computed Tomography for Detection of Left Atrial Appendage Filling Defect (Thrombus). Am J Cardiol 2014;113:173e177
- Singh NK, Nallamothu N, Zuck VP, et al. Left atrial appendage filling defects on 64-slice multidetector computed tomography in patients undergoing pulmonary vein isolation: predictors and comparison to trans- esophageal echocardiography. J Comput Assist Tomogr 2009; 33: 946-51.
- Xiaosan Wu, Congxia Wang, Chunyan Zhang, Yan Zhang, Faming Ding, Jiaojuan Yan. Computed tomography for detecting left atrial thrombus: a meta-analysis. Arch Med Sci 2012; 8, 6: 943-951.
- Kirchhof K, Welzel T, Mecke C, Zoubaa S, Sartor K. Differentiation of White, mixed, and red thrombi: value of CT in estimation of the prognosis of thrombolysis phantom study. Radiology 228(1):126-130
- Dianna M.E. Bardo and Paul Brown. Cardiac Multidetector Computed Tomography: Basic Physics of Image Acquisition and Clinical Applications. Current Cardiology Reviews, 2008, 4, 231-243.