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
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.
Journal of Cardiovascular Electrophysiology
Patient Isolation
Catheter ablation
Khan, M. N., Usmani, A., Noor, S., Elayi, S., Ching, C. K., Di Biase, L., ... Natale, A. (2008). 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. Journal of Cardiovascular Electrophysiology, 19(4), 356-358. https://doi.org/10.1111/j.1540-8167.2007.01070.x
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.
Khan, MN, Usmani, A, Noor, S, Elayi, S, Ching, CK, Di Biase, L, Patel, D, Burkhardt, JD, Cummings, J, Schweikert, R, Saliba, W & Natale, A 2008, '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', Journal of Cardiovascular Electrophysiology, vol. 19, no. 4, pp. 356-358. https://doi.org/10.1111/j.1540-8167.2007.01070.x
Khan MN, Usmani A, Noor S, Elayi S, Ching CK, Di Biase L et al. 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. Journal of Cardiovascular Electrophysiology. 2008 Apr;19(4):356-358. https://doi.org/10.1111/j.1540-8167.2007.01070.x
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.
@article{a1d3390b00874403a6ac8559a42f74f8,
title = "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",
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.",
keywords = "Atrial fibrillation, Catheter ablation, Computed tomography, Transesophageal echocardiography",
author = "Khan, {Mohammed N.} and Ali Usmani and Saira Noor and Samy Elayi and Ching, {Chi Keong} and {Di Biase}, Luigi and Dimpi Patel and Burkhardt, {J. David} and Jennifer Cummings and Robert Schweikert and Walid Saliba and Andrea Natale",
journal = "Journal of Cardiovascular Electrophysiology",
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
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
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology