Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation.
BACKGROUND
Computed tomography angiography (CTA) can identify and rule out left atrial appendage (LAA) thrombus when delayed imaging is also performed.


OBJECTIVE
In patients referred for CTA to evaluate pulmonary vein anatomy before the ablation of atrial fibrillation (AF) or left atrial flutter (LAFL), we sought to determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed LAA imaging into preprocedure care.


METHODS
After making delayed imaging of the LAA part of our routine preablation CTA protocol, we integrated early reporting of preablation CTA LAA imaging results into clinical practice as part of a formal protocol in June 2013. We then analyzed the effectiveness of this protocol by evaluating 320 AF/LAFL ablation patients with CTA imaging during the time period 2012-2014.


RESULTS
In CTA patients with delayed LAA imaging, the sensitivity and negative predictive values for LAA thrombus using intracardiac echocardiography or transesophageal echocardiography (TEE) as the reference standard were both 100%. Intracardiac echocardiography during ablation confirmed the absence of thrombus in patients with negative CTA or negative TEE results. No patients with either negative CTA results or equivocal CTA results combined with negative TEE results had strokes or transient ischemic attacks. Overall, the need for TEE procedures decreased from 57.5% to 24.0% during the 3-year period because of the CTA protocol.


CONCLUSIONS
Clinical integration of CTA delayed LAA imaging into the care of patients having catheter ablation of AF or LAFL is feasible, safe, and effective. Such a protocol could be used broadly to improve patient care.
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia. Electronic address: bilchick@virginia.edu.
Kenneth C
KC
Bilchick
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
Augustus
A
Mealor
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
Jorge
J
Gonzalez
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
Patrick
P
Norton
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
David
D
Zhuo
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
Pamela
P
Mason
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
John D
JD
Ferguson
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
Rohit
R
Malhotra
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
J
J
Michael Mangrum
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
Andrew E
AE
Darby
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
John
J
DiMarco
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
Klaus
K
Hagspiel
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
John
J
Dent
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
Christopher M
CM
Kramer
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia.
George J
GJ
Stukenborg
Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia.
Michael
M
Salerno
D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery; D001282:Atrial Flutter / Q000150:complications / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods*
Atrial fibrillation; Catheter ablation; Computed tomography angiography; Stroke; Transesophageal echocardiography