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  • Title: Transoesophageal echocardiography prior to catheter ablation could be avoided in atrial fibrillation patients with a low risk of stroke and without filling defects in the late-phase MDCT scan: A retrospective analysis of 783 patients.
    Author: Zhai Z, Tang M, Zhang S, Fang P, Jia Y, Feng T, Wang J.
    Journal: Eur Radiol; 2018 May; 28(5):1835-1843. PubMed ID: 29218612.
    Abstract:
    OBJECTIVES: To test whether multidetector computed tomography (MDCT) could completely replace transoesophageal echocardiography (TEE) to detect left atrial appendage (LAA) thrombi in atrial fibrillation (AF) patients using a large sample size. METHODS: 783 patients with AF who underwent MDCT and TEE before catheter ablation were retrospectively included. Demographic data were obtained. Two radiologists blinded to clinical data made the imaging diagnosis. RESULTS: Most of the patients (96.2 %) had a CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥ 75 years old (doubled), diabetes, stroke/transient ischaemic attack/thromboembolism (doubled), vascular disease, age 65-74 years, female sex) ≤ 3. Eight thrombi were identified by TEE, all of which were detected by MDCT; no thrombus was observed with TEE without the observation of filling defects by late-phase MDCT scanning in any of the patients. Using TEE as reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of MDCT for thrombus detection were 100 %, 95.74 % (95 % CI 94.33 %-97.15 %), 19.51 % (95 % CI 16.73 %-22.29 %) and 100 %, respectively. CONCLUSIONS: For AF patients with low risk of stroke, when MDCT images showed no filling defect in the late phase, TEE prior to catheter ablation can be avoided. KEY POINTS: • MDCT can help detect the presence of LAA thrombus. • TEE can be avoided when late-phase MDCT shows no filling defect. • TEE is required in patients whose MDCT images indicate thrombus.
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