title: Comparison of contrast enhanced 64-slice computed tomography and transesophageal echocardiography in detection of left atrial thrombus in patients with atrial fibrillation.
abstract: OBJECTIVE
  Recent advances in multi-slice computed tomography (MSCT) have allowed an improved analysis of left atrial (LA) and left atrial appendage (LAA) anatomy prior to catheter ablation of atrial fibrillation (AF). However, data regarding the ability of MSCT to identify LA/LAA thrombus are limited. This prospective study compared the efficacy of 64-slice contrast-enhanced computed tomography (64CCT) with transesophageal echocardiography (TEE) of the heart in the identification of LA/LAA thrombus.
  
  
  METHODS
  One-hundred and seventy consecutive patients scheduled for first-time catheter ablation of paroxysmal (n = 120) or persistent (n = 50) AF were enrolled for study. Each patient underwent non-gated 64CCT and TEE of the heart for exclusion of LA/LAA thrombus prior to ablation procedure.
  
  
  RESULTS
  Fourteen cases (8.2%) of LA/LAA thrombi were interpreted by 64CCT (ten false-positive, four true positive), whereas 11 actual thrombi (6.5%) were detected by TEE (seven false-negative by 64CCT) in the same population. Maximal dimension of TEE identified thrombi did not differ between the false-negative by 64CCT group and the true-positive group (17 +/- 6 vs. 18 +/- 5 mm P = 0.677). Results indicated 64CCT sensitivity = 36.4%, specificity = 93.7%, positive predictive value = 28.6%, and negative predictive value = 95.5% in the detection of LA/LAA thrombus. The Kappa value in evaluating the agreement between 64CCT and TEE for detection of LA/LAA thrombus was 0.267.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China. tangribo1994@yahoo.com.cn
authors.forename: Ri Bo
authors.initials: RB
authors.lastname: Tang
authors.forename: Jian Zeng
authors.initials: JZ
authors.lastname: Dong
authors.forename: Zhao Qi
authors.initials: ZQ
authors.lastname: Zhang
authors.forename: Zhi An
authors.initials: ZA
authors.lastname: Li
authors.forename: Xing Peng
authors.initials: XP
authors.lastname: Liu
authors.forename: Jun Ping
authors.initials: JP
authors.lastname: Kang
authors.forename: Rong Hui
authors.initials: RH
authors.lastname: Yu
authors.forename: De Yong
authors.initials: DY
authors.lastname: Long
authors.forename: Chang Sheng
authors.initials: CS
authors.lastname: Ma
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis*; D003287:Contrast Media; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media