Comparison of contrast enhanced 64-slice computed tomography and transesophageal echocardiography in detection of left atrial thrombus in patients with atrial fibrillation

Abstract

Compared to gold standard TEE, 64CCT was shown to be less reliable in the detection of LA/LAA thrombus prior to catheter ablation in patients with AF.

Atrial thrombi detection prior to pulmonary vein isolation: Diagnostic accuracy of cardiac computed tomography versus transesophageal echocardiography

“…Similarly, Hur et al [13] found a sensitivity and specificity of 89% and 100%. In contrast, Tang et al [10] conclude from CCT sensitivity and specificity of 36.4% and 93.7% that both modalities are necessary. Variation in results can partially be explained by inconsistency in CCT and TEE methodology.…”

“…Current literature includes both prospective and retrospective cross-sectional studies, and a meta-analysis [5,[7][8][9][10][11][12][13]18]. Study sizes have varied from 72 to 402 patients [7,9], yet current literature remains controversial.…”

“…Garcia [15] criticized Martinez et al [9] for suboptimal methodology in administration of contrast, possibly affecting visualization. The clinical impact of prospective and retrospective ECG-gating on CCT results has also been called into question [10], as have variations in patient positioning during CCT [19]. Lastly, the length of time between CCT and TEE has varied, as Martinez et al ensured CCT and TEE were conducted within 24 h, whereas Kim et al allowed a gap of up to one week [5,9,13].…”

“…Cardiac computed tomography (CCT) imaging is also required for procedural mapping. Although it has been demonstrated that CCT can also effectively rule out intracardiac thrombi [6], studies are small and results have been inconsistent in findings and methodology [5,[7][8][9][10][11][12][13][14]. For instance, the largest study on the subject by Martinez et al [9], reached the conclusion that CCT is sensitive enough to warrant the use of only CCT to rule out atrial thrombi, but this conclusion has been called into question for sub-optimal study methodology [15].…”

CT Imaging to Assess the Left Atrial Appendage Anatomy: Clinical Implications

“…However, transesophageal echocardiography is semi-invasive. Multidetector cardiac CT is emerging as a powerful diagnostic tool to detect LAA thrombosis (Kim et al, 2007, Shapiro et al, 2007, Singh et al, 2009, Tang et al, 2008, Tani et al, 2003. Tani et al evaluated the usefulness of CT for detecting LAA thrombi in patients with chronic atrial fibrillation as compared to transesophageal echocardiography (Tani et al, 2003).…”