Prone‐position computed tomography in the late phase for detecting intracardiac thrombi in the left atrial appendage before catheter ablation for atrial fibrillation

• Published in: Journal of cardiovascular electrophysiology Vol. 32; no. 7; pp. 1803 - 1811
• Main Authors: Nakamura, Rena, Oda, Atsuhito, Tachibana, Shinichi, Sudo, Koji, Shigeta, Takatoshi, Sagawa, Yuichiro, Kurabayashi, Manabu, Goya, Masahiko, Okishige, Kaoru, Sasano, Tetsuo, Yamauchi, Yasuteru
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2021; John Wiley and Sons Inc
• Subjects: Ablation; atrial fibrillation; Blood clots; Cardiac arrhythmia; cardiac thrombus; catheter ablation; Catheters; Computed tomography; Contrast media; Dosage; Echocardiography; Fibrillation; Original; prone position; Radiofrequency ablation; Thrombosis; Velocity; computed tomography; atrial fibrillation; catheter ablation; prone position; cardiac thrombus
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.15062

Background
Contrast computed tomography (CT) is a useful tool for the detection of intracardiac thrombi. We aimed to assess the accuracy of the late‐phase prone‐position contrast CT (late‐pCT) for thrombus detection in patients with persistent or long‐standing persistent atrial fibrillation (AF).
Methods
Early and late‐phase pCT were performed in 300 patients with persistent or long‐standing AF. If late‐pCT did not show an intracardiac contrast defect (CD), catheter ablation (CA) was performed. Immediately before CA, intracardiac echocardiography (ICE) from the left atrium was performed to confirm thrombus absence and the estimation of the blood velocity of the left atrial appendage (LAA). For patients with CDs on late‐pCT, CA performance was delayed, and late‐pCT was performed again after several months following oral anticoagulant alterations or dosage increases.
Results
Of the 40 patients who exhibited CDs in the early phase of pCT, six showed persistent CDs on late‐pCT. In the remaining 294 patients without CDs on late‐pCT, the absence of a thrombus was confirmed by ICE during CA. In all six patients with CD‐positivity on late‐pCT, the CDs vanished under the same CT conditions after subsequent anticoagulation therapy, and CA was successfully performed. Furthermore, the presence of residual contrast medium in the LAA on late‐pCT suggested a decreased blood velocity in the LAA ( ≤ 15 cm/s) (sensitivity = 0.900 and specificity = 0.621).
Conclusions
Late‐pCT is a valuable tool for the assessment of intracardiac thrombi and LAA dysfunction in patients with persistent or long‐standing persistent AF before CA.