Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation

Simonette T. Sawit, Ana Garcia-Alvarez, Bhavna Suri, Juan Gaztanaga, Leticia Fernandez-Friera, Jesus G. Mirelis, Michael D'Anca, Valentin Fuster, Javier Sanz, Mario J. Garcia

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33 Scopus citations

Abstract

Left atrial appendage (LAA) contrast filling defects are commonly found in patients undergoing multidetector cardiac computed tomography (CCT) before catheter ablation of atrial fibrillation. Delayed CCT allows quantification of the LAA delayed/initial attenuation ratio and improves accuracy for LAA thrombus detection, which may obviate routine transesophageal echocardiography (TEE) before ablation. CCT with contrast-enhanced scans (initial CCT) and with noncontrast-enhanced scans (delayed CCT) was performed in 176 patients. LAA was evaluated for filling defects. LAA apex, left atrial (LA) body, and ascending aorta (AA) attenuations (Hounsfield units) were measured on initial and delayed cardiac computed tomograms to calculate LAA, LA, LAA/LA, and LAA/AA attenuation ratios. LAA, initial LAA/LA, and initial LAA/AA attenuation ratios differed significantly in patients with versus without filling defects on cardiac computed tomogram, those with atrial fibrillation versus normal sinus rhythm, and those with abnormal left ventricular ejection fraction versus larger LA volumes (p <0.05). In 70 patients (40%) who underwent TEE, 13 LAA filling defects were seen on initial cardiac computed tomogram. Two defects persisted on delayed cardiac computed tomogram and thrombus was confirmed on transesophageal echocardiogram. Sensitivity, specificity, and positive and negative predictive values of initial CCT for LAA thrombi detection were 100%, 84%, 15%, and 100%, respectively. With delayed CCT these values increased to 100%. Intraobserver and interobserver reproducibilities for cardiac computed tomographic measurements were good (intraclass correlation 0.72 to 0.97, kappa coefficients 0.93 to 1.00). In conclusion, delayed CCT provided an increase in diagnostic accuracy of CCT for detection of LAA thrombus in patients with atrial fibrillation before ablation, which may decrease the need for routine TEE before the procedure.

Original languageEnglish (US)
Pages (from-to)677-684
Number of pages8
JournalAmerican Journal of Cardiology
Volume109
Issue number5
DOIs
StatePublished - Mar 1 2012

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sawit, S. T., Garcia-Alvarez, A., Suri, B., Gaztanaga, J., Fernandez-Friera, L., Mirelis, J. G., D'Anca, M., Fuster, V., Sanz, J., & Garcia, M. J. (2012). Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. American Journal of Cardiology, 109(5), 677-684. https://doi.org/10.1016/j.amjcard.2011.10.028