Low incidence of left atrial or left atrial appendage thrombus in patients with paroxysmal atrial fibrillation and normal EF who present for pulmonary vein antrum isolation procedure

Mohammed N. Khan, Ali Usmani, Saira Noor, Samy Elayi, Chi Keong Ching, Luigi Di Biase, Dimpi Patel, J. David Burkhardt, Jennifer Cummings, Robert Schweikert, Walid Saliba, Andrea Natale

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

LAA Thrombus in Patients with PAF. Introduction: The incidence of left atrial appendage (LAA) thrombus in patients with paroxysmal atrial fibrillation (PAF) who present for pulmonary vein antrum isolation procedure (PVAI) is unknown. Methods and Results: All consecutive patients from January 2000 to June 2004 who underwent a PVAI received a computed tomography (CT) to evaluate LAA thrombus before the procedure and 3 months post-PVAI. All patients were followed prospectively. One thousand two hundred twenty-one patients received a PVAI during the study dates. All patients received a CT pre-PVAI at 3 months, and 601 (49%) received a transesophageal echocardiography (TEE) pre-PVAI. Per protocol, all patients who had CT scans that were positive for LAA thrombus received a TEE. There were 9 patients who had LAA thrombus on CT scan, but only 3 had LAA thrombus on TEE. Using TEE as the gold standard, only 3 patients had an LAA thrombus before PVAI; of these patients, 2 had chronic AF with average ejection fraction (EF) of 48% and 1 patient had PAF with EF 25%. No patients with PAF and normal EF had LAA thrombus. Patients with LAA thrombus pre-PVAI had lower EF than patients without LAA thrombus (40% vs. 53%, P = 0.007) but had similar LA size (5.0 vs. 4.5 cm, P = 0.77). No other differences in baseline characteristics were noted. Conclusions: In this registry of 1,221 patients, we did not observe LA thrombus in PAF patients with normal EF who present for PVAI. Prescreening CT alone is likely to be sufficient in paroxysmal AF patients with normal EF, and the use of TEE may not be needed.

Original languageEnglish (US)
Pages (from-to)356-358
Number of pages3
JournalJournal of Cardiovascular Electrophysiology
Volume19
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

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Atrial Appendage
Pulmonary Veins
Atrial Fibrillation
Thrombosis
Incidence
Transesophageal Echocardiography
Tomography
Patient Isolation

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Computed tomography
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Low incidence of left atrial or left atrial appendage thrombus in patients with paroxysmal atrial fibrillation and normal EF who present for pulmonary vein antrum isolation procedure. / Khan, Mohammed N.; Usmani, Ali; Noor, Saira; Elayi, Samy; Ching, Chi Keong; Di Biase, Luigi; Patel, Dimpi; Burkhardt, J. David; Cummings, Jennifer; Schweikert, Robert; Saliba, Walid; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 19, No. 4, 04.2008, p. 356-358.

Research output: Contribution to journalArticle

Khan, Mohammed N. ; Usmani, Ali ; Noor, Saira ; Elayi, Samy ; Ching, Chi Keong ; Di Biase, Luigi ; Patel, Dimpi ; Burkhardt, J. David ; Cummings, Jennifer ; Schweikert, Robert ; Saliba, Walid ; Natale, Andrea. / Low incidence of left atrial or left atrial appendage thrombus in patients with paroxysmal atrial fibrillation and normal EF who present for pulmonary vein antrum isolation procedure. In: Journal of Cardiovascular Electrophysiology. 2008 ; Vol. 19, No. 4. pp. 356-358.
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abstract = "LAA Thrombus in Patients with PAF. Introduction: The incidence of left atrial appendage (LAA) thrombus in patients with paroxysmal atrial fibrillation (PAF) who present for pulmonary vein antrum isolation procedure (PVAI) is unknown. Methods and Results: All consecutive patients from January 2000 to June 2004 who underwent a PVAI received a computed tomography (CT) to evaluate LAA thrombus before the procedure and 3 months post-PVAI. All patients were followed prospectively. One thousand two hundred twenty-one patients received a PVAI during the study dates. All patients received a CT pre-PVAI at 3 months, and 601 (49{\%}) received a transesophageal echocardiography (TEE) pre-PVAI. Per protocol, all patients who had CT scans that were positive for LAA thrombus received a TEE. There were 9 patients who had LAA thrombus on CT scan, but only 3 had LAA thrombus on TEE. Using TEE as the gold standard, only 3 patients had an LAA thrombus before PVAI; of these patients, 2 had chronic AF with average ejection fraction (EF) of 48{\%} and 1 patient had PAF with EF 25{\%}. No patients with PAF and normal EF had LAA thrombus. Patients with LAA thrombus pre-PVAI had lower EF than patients without LAA thrombus (40{\%} vs. 53{\%}, P = 0.007) but had similar LA size (5.0 vs. 4.5 cm, P = 0.77). No other differences in baseline characteristics were noted. Conclusions: In this registry of 1,221 patients, we did not observe LA thrombus in PAF patients with normal EF who present for PVAI. Prescreening CT alone is likely to be sufficient in paroxysmal AF patients with normal EF, and the use of TEE may not be needed.",
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T1 - Low incidence of left atrial or left atrial appendage thrombus in patients with paroxysmal atrial fibrillation and normal EF who present for pulmonary vein antrum isolation procedure

AU - Khan, Mohammed N.

AU - Usmani, Ali

AU - Noor, Saira

AU - Elayi, Samy

AU - Ching, Chi Keong

AU - Di Biase, Luigi

AU - Patel, Dimpi

AU - Burkhardt, J. David

AU - Cummings, Jennifer

AU - Schweikert, Robert

AU - Saliba, Walid

AU - Natale, Andrea

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N2 - LAA Thrombus in Patients with PAF. Introduction: The incidence of left atrial appendage (LAA) thrombus in patients with paroxysmal atrial fibrillation (PAF) who present for pulmonary vein antrum isolation procedure (PVAI) is unknown. Methods and Results: All consecutive patients from January 2000 to June 2004 who underwent a PVAI received a computed tomography (CT) to evaluate LAA thrombus before the procedure and 3 months post-PVAI. All patients were followed prospectively. One thousand two hundred twenty-one patients received a PVAI during the study dates. All patients received a CT pre-PVAI at 3 months, and 601 (49%) received a transesophageal echocardiography (TEE) pre-PVAI. Per protocol, all patients who had CT scans that were positive for LAA thrombus received a TEE. There were 9 patients who had LAA thrombus on CT scan, but only 3 had LAA thrombus on TEE. Using TEE as the gold standard, only 3 patients had an LAA thrombus before PVAI; of these patients, 2 had chronic AF with average ejection fraction (EF) of 48% and 1 patient had PAF with EF 25%. No patients with PAF and normal EF had LAA thrombus. Patients with LAA thrombus pre-PVAI had lower EF than patients without LAA thrombus (40% vs. 53%, P = 0.007) but had similar LA size (5.0 vs. 4.5 cm, P = 0.77). No other differences in baseline characteristics were noted. Conclusions: In this registry of 1,221 patients, we did not observe LA thrombus in PAF patients with normal EF who present for PVAI. Prescreening CT alone is likely to be sufficient in paroxysmal AF patients with normal EF, and the use of TEE may not be needed.

AB - LAA Thrombus in Patients with PAF. Introduction: The incidence of left atrial appendage (LAA) thrombus in patients with paroxysmal atrial fibrillation (PAF) who present for pulmonary vein antrum isolation procedure (PVAI) is unknown. Methods and Results: All consecutive patients from January 2000 to June 2004 who underwent a PVAI received a computed tomography (CT) to evaluate LAA thrombus before the procedure and 3 months post-PVAI. All patients were followed prospectively. One thousand two hundred twenty-one patients received a PVAI during the study dates. All patients received a CT pre-PVAI at 3 months, and 601 (49%) received a transesophageal echocardiography (TEE) pre-PVAI. Per protocol, all patients who had CT scans that were positive for LAA thrombus received a TEE. There were 9 patients who had LAA thrombus on CT scan, but only 3 had LAA thrombus on TEE. Using TEE as the gold standard, only 3 patients had an LAA thrombus before PVAI; of these patients, 2 had chronic AF with average ejection fraction (EF) of 48% and 1 patient had PAF with EF 25%. No patients with PAF and normal EF had LAA thrombus. Patients with LAA thrombus pre-PVAI had lower EF than patients without LAA thrombus (40% vs. 53%, P = 0.007) but had similar LA size (5.0 vs. 4.5 cm, P = 0.77). No other differences in baseline characteristics were noted. Conclusions: In this registry of 1,221 patients, we did not observe LA thrombus in PAF patients with normal EF who present for PVAI. Prescreening CT alone is likely to be sufficient in paroxysmal AF patients with normal EF, and the use of TEE may not be needed.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Computed tomography

KW - Transesophageal echocardiography

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