Detection of left atrial thrombus by intracardiac echocardiography in patients undergoing ablation of atrial fibrillation

Sriram, Chenni S.; Banchs, Javier E.; Moukabary, Talal; Moradkhan, Raman; González, Mario D.

doi:10.1007/s10840-015-0008-2

Cited by 35 publications

(23 citation statements)

References 49 publications

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“…It has been shown that intracardiac echocardiography may exclude a thrombus in some patients with positive TEE results; however, the opposite can also occur. 17 Nevertheless, TEE remains the gold standard for the detection of LAA and LA thrombus and the decision whether it is safe to proceed with AF ablation. In our study, TEE allowed to identify the presence of a definite LAA thrombus in 6.6% of the patients and a high probability of a thrombus based on dense echo contrast in 10% of the patients, which is in line with literature data.…”

Section: Patients and Methods Study Populationmentioning

confidence: 99%

Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: beyond the CHA2DS2VASc score

Sikorska¹,

Pilichowska-Paszkiet²,

Sikora-Frąc³

et al. 2015

Polish Archives of Internal Medicine

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INTRODUCTION Atrial fibrillation (AF) increases the risk of thromboembolic events, including ischemic stroke, by promoting clot formation in the left atrial appendage (LAA). 1 The risk of stroke in patients with AF varies widely depending on age, clinical variables, and cardiac structure or function. Accordingly, several stroke risk stratification systems for AF patients have been developed, with the CHA 2 DS 2 VASc scale being the

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Section: Patients and Methods Study Populationmentioning

confidence: 99%

Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: beyond the CHA2DS2VASc score

Sikorska¹,

Pilichowska-Paszkiet²,

Sikora-Frąc³

et al. 2015

Polish Archives of Internal Medicine

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“…When analyzing retrospective data looking at those who underwent preprocedural TEE and intraprocedural ICE imaging, ICE was able to identify thrombus in seven of 122 patients who were either negative or inconclusive on TEE scan. 32 In a separate study, seven of nine patients who were identified as "equivocal" or as demonstrating "high suspicion" for LAA thrombus on TEE were resolved by ICE imaging, with subsequent successful completion of AF ablation in those patients. 33 ICE imaging is, however, subject to a high degree of variability amongst those manipulating the probe, with optimal views of the LAA originating with the catheter in the right ventricular inflow tract, right ventricular outflow tract, or pulmonary artery all reported.…”

Section: Alternative Strategies: Computed Tomography Intracardiac Ecmentioning

confidence: 98%

Left Atrium and Left Atrial Appendage Screening Prior to Atrial Fibrillation Ablation: A Comprehensive Review of the Literature

Serafini

Krishnan

2018

J Innov Cardiac Rhythm Manage

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In the past decade, certain patient groups have been observed to have a presumptive lower incidence of left atrial (LA)/LA appendage (LAA) thrombus, particularly those who have no or minimal comorbidities. This has led to the question of whether a preprocedural evaluation of the LA/LAA is necessary in every patient, or if it can be avoided in certain patient populations. The answer to this is further complicated by the possibility of newer anticoagulation approaches affecting the incidence of intracardiac thrombus, including uninterrupted warfarin therapy and uninterrupted novel oral anticoagulant (NOAC) therapy, both of which are becoming more common. In this study, we conducted a comprehensive review of the literature addressing these questions in an attempt to summarize current approaches to evaluating the LA/LAA prior to ablation in order to elucidate the strategies that are currently being employed, to determine which strategies are becoming more favorable for use, and to identify what topics can or should be targeted for future study. In addition, this paper seeks to address the following specific questions: is ruling out LA/ LAA thrombus necessary in all patients prior to atrial fibrillation (AF) ablation? Are there any identifiable patient populations at reliably lower risk who could potentially avoid LA/LAA thrombus screening prior to AF ablation? What are the current strategies being employed by electrophysiologists in the published literature? What is the opinion of the current literature on warfarin and NOAC drugs as they pertain to the incidence of LA/LAA thrombus prior to AF ablation, and how does each fit into the current treatment strategies for the prevention of procedural thromboembolism? Finally, what is the future of preprocedural intracardiac thrombus evaluation prior to AF ablation, and what steps can be taken to ensure that the risk to the patient is minimized while improving laboratory efficiency and avoiding unnecessary costs?

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“…One study found that when maneuvering the ICE catheter into the right atrium, coronary sinus, and right ventricular inflow tract, ICE was able to identify thrombus in patients with an inconclusive TEE. 1 Another study found that visualization of the LAA improved when the operator viewed from the pulmonary artery. 2 Additional studies concur that ICE can provide detailed imaging of the LAA and may diagnose the presence of thrombus.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…While the LAA may be difficult to visualize with ICE from the right atrium, maneuvering the ICE catheter within the right ventricle and pulmonary artery can provide detailed imaging. One study found that when maneuvering the ICE catheter into the right atrium, coronary sinus, and right ventricular inflow tract, ICE was able to identify thrombus in patients with an inconclusive TEE . Another study found that visualization of the LAA improved when the operator viewed from the pulmonary artery .…”

Section: Introductionmentioning

confidence: 99%

A standardized protocol to reliably visualize the left atrial appendage with intracardiac echocardiography: Importance of multiple imaging sites

et al. 2018

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Detection of left atrial thrombus by intracardiac echocardiography in patients undergoing ablation of atrial fibrillation

Cited by 35 publications

References 49 publications

Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: beyond the CHA2DS2VASc score

Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: beyond the CHA2DS2VASc score

Left Atrium and Left Atrial Appendage Screening Prior to Atrial Fibrillation Ablation: A Comprehensive Review of the Literature

A standardized protocol to reliably visualize the left atrial appendage with intracardiac echocardiography: Importance of multiple imaging sites

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