Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation.
Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation.
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DOI：
10.1016/j.hrthm.2015.09.002
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发表时间：
2016-01
期刊：
影响因子：
5.5
通讯作者：
Salerno M
中科院分区：
文献类型：
--
作者：
Bilchick KC;Mealor A;Gonzalez J;Norton P;Zhuo D;Mason P;Ferguson JD;Malhotra R;Michael Mangrum J;Darby AE;DiMarco J;Hagspiel K;Dent J;Kramer CM;Stukenborg GJ;Salerno M
当同时进行延迟成像时，计算机断层扫描血管造影（CTA）可以识别并排除左心耳（LAA）血栓。在房颤或非典型左心房扑动（AF）消融前转诊接受肺静脉解剖CTA的患者中，我们试图确定一种新的临床方案将LAA CTA延迟成像结果整合到术前护理中的有效性。在将LAA延迟成像作为我们常规消融前CTA方案的一部分后，我们于2013年6月将消融前CTA LAA成像结果的早期报告整合到临床实践中，作为正式方案的一部分。然后，我们通过评价2012-2014年期间320例使用CTA成像的AF消融患者来分析该方案的有效性。在延迟LAA成像的CTA患者中，以心内超声心动图（ICE）或经食管超声心动图（TEE）作为参考标准，LAA血栓的敏感性和阴性预测值均为100%。消融期间ICE证实CTA或TEE阴性患者无血栓。CTA阴性或CTA不明确且TEE阴性的患者均未发生卒中或短暂性脑缺血发作。总体而言，由于CTA方案，3年期间TEE需求从57.5%降至24.0%。将CTA与延迟LAA成像临床整合到AF导管消融患者的护理中是可行、安全和有效的。这样的协议可以广泛应用于改善患者护理。
Computed tomography angiography (CTA) can identify and rule out left atrial appendage (LAA) thrombus when delayed imaging is also performed. In patients referred for CTA for pulmonary vein anatomy prior to ablation of atrial fibrillation or atypical left atrial flutter (AF), we sought to determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed imaging of the LAA into pre-procedure care. After making delayed imaging of the LAA part of our routine pre-ablation CTA protocol, we integrated early reporting of pre-ablation 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 ablation patients with CTA imaging during 2012–2014. Among CTA patients with delayed LAA imaging, the sensitivity and negative predictive values for LAA thrombus with intracardiac echocardiography (ICE) or transesophageal echocardiograms (TEEs) as the reference standard were both 100%. ICE during ablation confirmed absence of thrombus in patients with a negative CTA or negative TEE. No patients with either a negative CTA or an equivocal CTA combined with a negative TEE had strokes or transient ischemic attacks. Overall, the need for TEEs decreased from 57.5% to 24.0% during the 3-year period as a result of the CTA protocol. Clinical integration of CTA with delayed LAA imaging into the care of patients having catheter ablation of AF is feasible, safe, and effective. Such a protocol could be applied broadly to improve patient care.