| 1. Ismail TF, Panikker S, Markides V, et al. CT imaging for left atrial appendage closure: a review and pictorial essay. [Review]. J Cardiovasc Comput Tomogr. 9(2):89-102, 2015 Mar-Apr. |
Review/Other-Dx |
N/A |
To review and provide a pictorial essay of computed tomography (CT) imaging for left atrial appendage closure. |
No abstract available. |
4 |
| 2. Korsholm K, Jensen JM, Nielsen-Kudsk JE. Cardiac Computed Tomography for Left Atrial Appendage Occlusion: Acquisition, Analysis, Advantages, and Limitations. [Review]. Interv Cardiol Clin. 7(2):229-242, 2018 Apr. |
Review/Other-Dx |
N/A |
To review cardiac computed tomography for left atrial appendage occlusion acquisition, analysis, advantages, and limitations. |
No abstract available. |
4 |
| 3. Beigel R, Wunderlich NC, Ho SY, Arsanjani R, Siegel RJ. The left atrial appendage: anatomy, function, and noninvasive evaluation. [Review]. JACC Cardiovasc Imaging. 7(12):1251-65, 2014 Dec. |
Observational-Dx |
N/A |
To present the current data regarding left atrial appendage (LAA) anatomy, LAA function, and LAA imaging using the currently available noninvasive imagingmodalities. |
No results stated in the abstract. |
4 |
| 4. Prosper A, Shinbane J, Maliglig A, Saremi F, Wilcox A, Lee C. Left Atrial Appendage Mechanical Exclusion: Procedural Planning Using Cardiovascular Computed Tomographic Angiography. [Review]. J Thorac Imaging. 35(4):W107-W118, 2020 Jul. |
Review/Other-Dx |
N/A |
To review the procedural planning using cardiovascular computed tomography for left atrial appendage mechanical exclusion. |
No results stated in the abstract. |
4 |
| 5. Kanaji Y, Miyazaki S, Iwasawa J, et al. Pre-procedural evaluation of the left atrial anatomy in patients referred for catheter ablation of atrial fibrillation. J Cardiol. 67(1):115-21, 2016 Jan. |
Review/Other-Dx |
1,040 patients |
To evaluate the prevalence and morphological characteristics of anatomical variants that could influence atrial fibrillation (AF) ablation procedures. |
One thousand forty consecutive patients (62±10 years, 243 female, 644 paroxysmal AF) undergoing pre-procedural imaging with a 320-row CT and their first AF ablation procedure were analyzed. A total of 194 (18.7%) patients had anatomical variants. Left, right, and inferior common PVs were observed in 118, 5, and 6 patients, respectively. Three right and left PVs were observed in 44 and 4 patients, respectively. Three patients had remnants of PVs after lobectomies, and significant PV stenosis was observed in one. Supernumerary PVs that drained into the LA and diverticula were observed in eight patients. One patient had a string-like structure connecting the LA septum and posterior LA, and the others had membranous structures incompletely compartmentalizing the LA. Three patients had persistent left superior vena cavae, two strong deviations of the LA and PVs, and one dexiocardia. All patients underwent successful PV isolation during the index procedure. |
4 |
| 6. Marrouche NF, Greene T, Dean JM, et al. Efficacy of LGE-MRI-guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design. Journal of Cardiovascular Electrophysiology. 32(4):916-924, 2021 04. |
Observational-Dx |
900 patients |
To assess the safety and efficacy of targeting atrial fibrosis during ablation of persistent AF patients in improving procedural outcomes. |
The DECAAF II trial is the first prospective, randomized, multicenter trial of patients with persistent AF using imaging defined atrial fibrosis as a treatment target. The trial will help define an optimal approach to catheter ablation of persistent AF, further our understanding of influencers of ablation lesion formation, and refine selection criteria for ablation based on atrial myopathy burden. |
4 |
| 7. Guglielmo M, Baggiano A, Muscogiuri G, et al. Multimodality imaging of left atrium in patients with atrial fibrillation. [Review]. J Cardiovasc Comput Tomogr. 13(6):340-346, 2019 Nov - Dec. |
Review/Other-Dx |
N/A |
To focus on the additional value of advanced cardiac imaging including cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR), in the assessment of left atrial (LA) anatomy, in ruling out of LA thrombus and in guiding catheter ablation (CA) of atrial fibrillation (AF) and left atrial appendage (LAA) occlusion |
No results stated in the abstract. |
4 |
| 8. Korsholm K, Berti S, Iriart X, et al. Expert Recommendations on Cardiac Computed Tomography for Planning Transcatheter Left Atrial Appendage Occlusion. [Review]. JACC Cardiovasc Interv. 13(3):277-292, 2020 02 10. |
Review/Other-Dx |
N/A |
To provide a protocol for the preparation, acquisition, and interpretation of cardiac computed tomographic imaging in pre-procedural planning of left atrial appendage occlusion. |
No results stated in the abstract. |
4 |
| 9. Rajiah P, Alkhouli M, Thaden J, Foley T, Williamson E, Ranganath P. Pre- and Postprocedural CT of Transcatheter Left Atrial Appendage Closure Devices. Radiographics. 41(3):680-698, 2021 May-Jun. |
Observational-Dx |
N/A |
To identify the role of computed tomography (CT) in the evaluation of patients for transcatheter left atrial appendage (LAA) closure (LAAC), to describe the optimal CT protocol for pre- and postprocedural evaluation for transcatheter LAAC and to discuss the common postprocedural complications of LAAC. |
No results stated in the abstract. |
4 |
| 10. Saw J, Lopes JP, Reisman M, McLaughlin P, Nicolau S, Bezerra HG. Cardiac Computed Tomography Angiography for Left Atrial Appendage Closure. [Review]. Can J Cardiol. 32(8):1033.e1-9, 2016 08. |
Review/Other-Dx |
N/A |
To review the practical utility of cardiac computed tomography angiography (CCTA) for left atrial appendage (LAA) closure |
No results stated in the abstract. |
4 |
| 11. Rajiah P, Kirsch J, Bolen MA, et al. ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded). J Am Coll Radiol 2021;18:S83-S105. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for nonischemic myocardial disease with clinical manifestations (ischemic cardiomyopathy already excluded). |
No results stated in abstract. |
4 |
| 12. White RD, Kirsch J, Bolen MA, et al. ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure. J Am Coll Radiol 2018;15:S418-S31. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected new-onset and known nonacute heart failure. |
No results stated in abstract. |
4 |
| 13. Litmanovich D, Hurwitz Koweek LM, Ghoshhajra BB, et al. ACR Appropriateness Criteria® Chronic Chest Pain-High Probability of Coronary Artery Disease: 2021 Update. J Am Coll Radiol 2022;19:S1-S18. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic chest pain-high probability of coronary artery disease. |
No results stated in abstract. |
4 |
| 14. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 15. Starek Z, Lehar F, Jez J, et al. Periprocedural 3D imaging of the left atrium and esophagus: comparison of different protocols of 3D rotational angiography of the left atrium and esophagus in group of 547 consecutive patients undergoing catheter ablation of the complex atrial arrhythmias. Int J Cardiovasc Imaging. 32(7):1011-9, 2016 Jul. |
Observational-Dx |
547 patients |
To test various acquisition protocols of the 3D rotational angiography (3DRA) and attempt to define the parameters influencing the success of the protocols. |
From August 2010 to November 2014, 3DRA of the LA using the Philips Allura FD 10 X-ray system was performed in 547 consecutive patients using right atrial and left atrial protocols. Visualization of the esophagus was performed after oral administration of a contrast agent. Patients were monitored for success (creation of a useful 3D models) and evaluated for a number of parameters affecting the success of 3DRA. The success of the RA protocol was 88.89 % with and 91.91 % without esophagus imaging. The success of the LA protocol was 97.42 % with and 94.54 % without esophagus imaging. The only factor reducing the success of the RA protocol was BMI; the LA protocol was not influenced by any factor. Ventricular fibrillation induced in two patients was successfully treated with defibrillation. 3DRA of the LA is a reliable method that supports catheter ablation of complex atrial arrhythmias. The LA protocol with esophagus imaging was significantly more reliable than the RA protocol; the other protocols were comparable. The RA protocol may be negatively affected by high BMI. Simultaneous imaging of the esophagus is safe and feasible, and the LA protocol can be recommended. |
3 |
| 16. Yamaji H, Hina K, Kawamura H, et al. Sufficient pulmonary vein image quality of non-enhanced multi-detector row computed tomography for pulmonary vein isolation by catheter ablation. Europace. 14(1):52-9, 2012 Jan. |
Observational-Tx |
50 patients |
To evaluate the quality of non-enhanced multi-detector row computed tomography (MDCT) images of the pulmonary vein (PV) and the clinical results of catheter ablation to isolate the PV for treatment of atrial fibrillation (AF) without the use of contrast medium in patients with chronic kidney disease (CKD). |
We compared PV images quantitatively and qualitatively between non-enhanced and enhanced images (n= 50). Procedural parameters and clinical outcomes were compared between catheter ablation for AF referring solely to non-enhanced MDCT in CKD patients (n= 20) and using enhanced MDCT images integrated with electroanatomic mapping in non-CKD patients (n= 30). In gross anatomy, complete agreement was obtained between non-enhanced and enhanced MDCT images. Bland–Altman plots and cumulative coefficient variation showed good agreement in PV diameter determination between non-enhanced and enhanced MDCT images. There were no statistically significant differences in procedural or fluoroscopic times between PV isolation only referring to non-enhanced MDCT images and that using enhanced MDCT images integrated with electroanatomic mapping. Similarly, the ablation success rate and AF-free status at 3 months after PV isolation did not differ between PV isolation referring only to non-enhanced MDCT images and that using an electroanatomic integration system. No complications occurred in PV isolation with or without enhanced MDCT. |
2 |
| 17. Munir S, Chang JH, Salahudeen SR, et al. Atrial thrombi detection prior to pulmonary vein isolation: diagnostic accuracy of cardiac computed tomography versus transesophageal echocardiography. Cardiol J. 22(5):576-82, 2015. |
Observational-Dx |
51 patients |
To determine the utility of cardiac computed tomography (CCT) for detection of atrial thrombi as compared to transesophageal echocardiography (TEE). |
A total of 51 patients undergoing PVI (mean age 59.4 ± 9.5 years; 75% male; ejection fraction 60 ± 12%) had both TEE and CCT in timely fashion. By TEE, 0 left atrial appendage (LAA) thrombi were identified with mild to moderate spontaneous echo contrast in 4 patients. By CCT, 2 definite LAA thrombi were identified and thrombi in 4 patients could not be ruled out. Specificity, positive predictive value, and negative predictive value for CCT were 88%, 0%, and 100%, respectively. |
2 |
| 18. Guha A, Dunleavy MP, Hayes S, et al. Accuracy of contrast-enhanced computed tomography for thrombus detection prior to atrial fibrillation ablation and role of novel Left Atrial Appendage Enhancement Index in appendage flow assessment. Int J Cardiol. 318:147-152, 2020 Nov 01. |
Observational-Dx |
590 patients |
To evaluate diagnostic accuracy of different protocols of contrast enhanced computed tomography venogram (CTV) for LAA thrombus detection in patients undergoing AF ablation and study the correlation of the novel LAA enhancement index (LAA-EI) to LAA flow velocity obtained using transesophageal echocardiography (TEE). |
590 patients with 45.6% non-ECG-gated without delayed imaging, 26.9% non-ECG-gated with delayed imaging and 27.5% ECG-gated with delayed imaging, were included in the study. All three protocols had 100% negative predictive value with improvement in specificity from 61.8% to 98.1% upon adding delayed imaging. The LAA-EI correlated significantly with reduced LAA flow velocities (r = 0.45, p < .0001). The mean LAA emptying velocity in patients with LAA-EI of = 0.6 was significantly lower than in those with LAA-EI of >0.6 (36.2 cm/s [95% CI: 32.6-39.7] vs, (58 cm/s [95% CI 55.3-60.8]), respectively (p < .0001). |
2 |
| 19. Sawit ST, Garcia-Alvarez A, Suri B, et al. Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation. Am J Cardiol. 109(5):677-84, 2012 Mar 01. |
Observational-Dx |
176 patients |
To determine if delayed cardiac computed tomographic (CCT) would improve the accuracy for left atrial appendage (LAA) thrombus detection. |
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). |
2 |
| 20. Hong SJ, Kim JY, Kim JB, et al. Multidetector computed tomography may be an adequate screening test to reduce periprocedural stroke in atrial fibrillation ablation: a multicenter propensity-matched analysis. Heart Rhythm. 11(5):763-70, 2014 May. |
Observational-Dx |
1147 patients |
The purpose of this study was to evaluate whether screening with multidetector computed tomography (MDCT) is sufficient for preventing periprocedural stroke. |
Patient baseline characteristics were comparable between the matched groups. In group 1 (n = 412), thrombi were detected in 4 patients (1.0%) on TEE, and ablation was not performed. These patients also showed thrombi (n = 3) or blood stasis (n = 1) on MDCT. For thrombi detection, MDCT had sensitivity and negative predictive value of 100%. In group 2 (n = 412), thrombi were detected in 7 patients (1.7%) on MDCT. Of these patients , 2 (0.5%) also showed thrombi on TEE. Periprocedural stroke incidence did not differ between the groups (0.2% each, P = 1.0). |
3 |
| 21. Akhtar T, Wallace R, Daimee UA, et al. Transition from transesophageal echocardiography to cardiac computed tomography for the evaluation of left atrial appendage thrombus prior to atrial fibrillation ablation and incidence of cerebrovascular events during the COVID-19 pandemic. J Cardiovasc Electrophysiol. 32(12):3125-3134, 2021 12. |
Observational-Dx |
637 patients |
To describe our experience with transitioning to the pre-ablation cardiac computed tomography (CT) approach for the assessment of left atrial appendage (LAA) thrombus during the COVID-19 pandemic. |
A total of 637 patients (pre-COVID n = 424, post-COVID n = 213) were studied. The mean age was 65.6 ± 10.1 years in the total cohort, and the majority were men. There was a significant increase in pre-ablation CT imaging from pre- to post-COVID cohort (74.8% vs. 93.9%, p = .01), with a significant reduction in TEEs (34.6% vs. 3.7%, p = .01). One patient in the post-COVID cohort developed CVE following negative pre-ablation CT. However, the incidence of peri-procedural CVE between both cohorts remained statistically unchanged (0% vs. 0.4%, p = .33). |
3 |
| 22. Nedios S, Kosiuk J, Koutalas E, et al. Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 43(3):237-44, 2015 Sep. |
Observational-Dx |
103 patients |
To analyze the value of different left atrial (LA) dimensions derived from computed tomography (CT) or echocardiography data, as predictors of long-term success after catheter ablation of atrial fibrillation (AF) and to identify the best predictive single-linear dimension. |
Patients with persistent AF (n=40) had significantly larger LA size than those with paroxysmal AF (n=63). After 26±14 months, 31 (30 %) patients had AF recurrence. Univariate Cox regression analysis revealed that LA-D, LA-SI, LA-TV, LAV, and LAV-index (LAV/body surface area) were associated with AF recurrence. Multivariate Cox regression analysis revealed that LAV was the strongest independent predictor of AF recurrence (HR=1.011 per ml, 95 % CI 1.003–1.020, p=0.002). LA-TV had the best correlation with LAV (r=0.69, p<0.01) and was the strongest single-linear predictor (HR=1.07 per mm, 95 % CI 1.022–1.121, p=0.004). Independent of LA-D, an LA-TV>74.5 mm predicted AF recurrence similarly to LAV>126 ml. |
3 |
| 23. Skala T, Tudos Z, Homola M, et al. The impact of ECG synchronization during acquisition of left-atrium computed tomography model on radiation dose and arrhythmia recurrence rate after catheter ablation of atrial fibrillation - a prospective, randomized study. Bratisl Lek Listy. 120(3):177-183, 2019. |
Observational-Dx |
62 patients |
To provide a prospective, randomized, blinded comparison of multi-detector computed tomography (MDCT) image quality between the ECG-gated and helical non-gated techniques, comparison of the radiation dose between the two methods, |
There was no difference between the groups in CA length (131.61±32.57 vs 119.84±33.18 min; p=0.108), CA fluoroscopy time (4.48±2.19 vs 3.89±1.83 min; p=0.251), CA fluoroscopy dose (3.99±2.79 vs 3.91 vs2.91 Gy*cm2; p=0.735), visual data quality (1.77±0.88 vs 2.0±0.63; p=0.102) and registration error (2.42±0.72 vs 2.43±0.46 mm; p=0.612). We found a significant difference in CT Dose index (89.55±5.99 vs 19.19±4.33 mGy; p<0.0001) and Dose Length product (1438.87±147.75 vs 328.21±73.83 mGy*cm; p<0.0001). Twelve months after CA, 25 of 31 patients in the gated group and 24 of 31 patients in the non-gated group were free of AF (80.65 vs 77.42 %; p=0.838). |
3 |
| 24. Iwayama T, Arimoto T, Ishigaki D, et al. The Clinical Value of Nongated Dual-Source Computed Tomography in Atrial Fibrillation Catheter Ablation. J Cardiovasc Electrophysiol. 27(1):34-40, 2016 Jan. |
Observational-Dx |
60 patients |
To compare 3-dimensional computed tomography (CT) images of the pulmonary vein (PV) and left atrium (LA)– constructed by electrocardiography(ECG)-gated 64-multidetector computed tomography (MDCT) (group I), ECG-gated 128-dual-source CT (DSCT) (group II), and nongated 128-DSCT (group III). |
The study enrolled 60 patients who were randomly assigned in a 1: 1: 1 ratio to undergo ECG-gated 64-slice multidetector computed tomography (MDCT; group I, n = 20), ECG-gated 128-DSCT (group II, n = 20), and nongated 128-DSCT (group III, n = 20). The total amount of contrast media was lower in groups II and III compared with group I (I: 54.7 ± 5.6, II: 26.6 ± 2.7, and III: 28.7 ± 6.9 mL, P < 0.001). The CT dose index was lower in groups II and III compared with group I (I: 73.1 ± 5.2, II: 3.5 ± 0.1, and III: 3.7 ± 0.1 mGy, P < 0.001). The dose length product was lower in groups II and III compared with group I (I: 1154.8 ± 82.8, II: 75.4 ± 2.3, and III: 77.2 ± 1.9 mGy × cm, P < 0.001). The total CT effective radiation dose was lower in groups II and III compared with group I (I: 16.2 ± 1.2, II: 1.1 ± 0.1, and III: 1.1 ± 0.1 mSv, P < 0.001). The total CT scan duration was shorter in group III compared with groups I and II (I: 30.8 ± 2.2, II: 23.4 ± 3.6, and III: 16.0 ± 2.4 minutes, P < 0.001). There were no significant differences in quality for integrated electroanatomical mapping (EAM) and parameters associated with PV isolation among the 3 groups. |
3 |
| 25. Bilchick KC, Mealor A, Gonzalez J, et al. Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation. Heart Rhythm. 13(1):12-9, 2016 Jan. |
Review/Other-Dx |
320 AF ablation patients with CTA imaging |
To determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed LAA imaging into preprocedure care. |
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. |
4 |
| 26. Rustogi R, Galizia M, Thakrar D, et al. Steady-state MRA techniques with a blood pool contrast agent improve visualization of pulmonary venous anatomy and left atrial patency compared with time-resolved MRA pre- and postcatheter ablation in atrial fibrillation. J Magn Reson Imaging. 42(5):1305-13, 2015 Nov. |
Observational-Dx |
21 patients |
To compare steady-state magnetic resonance angiography (SS-MRA), using a blood pool contrast agent, with the established technique of time-resolved MRA (TR-MRA), in pulmonary vein mapping and left atrial patency. |
Overall intertechnique mean difference for any pulmonary vein orthogonal measurement and area was 0.02 ± 0.34 cm (P = 0.705), and 0.2 ± 0.08 cm(2) (P < 0.001). Interobserver correlation was strong for diameter and area measurements using the three methods with a range of 0.72-0.94, and 0.87-0.97, respectively. Left atrial appendage image quality score for TR-MRA was significantly lower than the other two methods (P < 0.001). Both observers detected more stenosis on inversion recovery (IR)-True FISP compared to TR-MRA and IR-FLASH. |
2 |
| 27. Zghaib T, Shahid A, Pozzessere C, et al. Validation of contrast-enhanced time-resolved magnetic resonance angiography in pre-ablation planning in patients with atrial fibrillation: comparison with traditional technique. Int J Cardiovasc Imaging. 34(9):1451-1458, 2018 Sep. |
Observational-Dx |
100 patients |
To evaluate whether contrast-enhanced time-resolved magnetic resonance angiography (TR-MRA), a dynamic multiphase sequence that does not rely on bolus timing, is a viable alternative method to conventional 3D fast-long angle shot contrast-enhanced magnetic resonance angiography (CE-MRA). |
TR-MRA had significantly higher overall image quality (3.10 ±0.69 vs. 2.42 ±0.69, p<0.0001), and LA opacification scores (3.33 ±0.70 vs. 2.15 ±1.13, p<0.0001) compared to CE-MRA. The proportion of diagnostically visualized pulmonary veins was 137/150 (91%) in the CE-MRA group vs. 147/150 (98%) with TR-MRA (p=0.010). Both SNR and CNR were higher with TR-MRA vs. CE-MRA (277.9 ±48.9 vs 106.8 ±41, p=0.002 and 100.3 ±41.7 vs. 70.7 ±48.0, p=0.002, respectively). Inter-reader variance of individual PV measurements for each of the MR techniques ranged between 0.62 and 1.47mm and the ICC for vein measurements was higher with TR-MRA (range: 0.62–0.81) compared to CE-MRA (range: 0.47–0.64). |
2 |
| 28. Kitkungvan D, Nabi F, Ghosn MG, et al. Detection of LA and LAA Thrombus by CMR in Patients Referred for Pulmonary Vein Isolation. JACC Cardiovasc Imaging. 9(7):809-818, 2016 07. |
Observational-Dx |
261 patients |
To evaluate the diagnostic performance of a comprehensive, multicomponent cardiac magnetic resonance (CMR) study for assessment of left atrial (LA) and left atrial appendage (LAA) thrombus. |
During the study period, 261 patients were assessed. The median CHA2DS2VASc (congestive heart failure, hypertension, age =75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score was 2, and 73.6% of patients were undergoing anticoagulation therapy. CMR and TEE were performed within 1.3 ± 2.3 days. LA/LAA thrombi were discovered in 9 patients (3.5%) by using TEE. Among the CMR techniques performed, long TI DE-CMR had the highest diagnostic accuracy (99.2%), sensitivity (100%), and specificity (99.2%), followed by contrast-enhanced magnetic resonance angiography (accuracy 94.3%; sensitivity 66.7%; and specificity 95.2%) and cine-CMR (accuracy 91.6%; sensitivity 66.7%; and specificity 92.5%). |
3 |
| 29. Shigenaga Y, Okajima K, Ikeuchi K, et al. Usefulness of non-contrast-enhanced MRI with two-dimensional balanced steady-state free precession for the acquisition of the pulmonary venous and left atrial anatomy pre catheter ablation of atrial fibrillation: Comparison with contrast enhanced CT in clinical cases. J Magn Reson Imaging. 43(2):495-503, 2016 Feb. |
Observational-Dx |
66 patients |
To investigate the feasibility of substituting non-contrast-enhanced MR (non-CE-MR) imaging with a two-dimensional (2D) balanced steady-state free precession (b-SSFP) sequence for contrast-enhanced computed tomography (CE-CT) for atrial fibrillation (AF) ablation. |
The image score was nearly 0.5 point higher with the CE-CT method. However, the procedural results such as the surface registration error (1.0 [0.8-1.6] mm versus 1.0 [0.8-1.35] mm, P = 0.88) and procedure time (185 [159-199] min versus 185 [142-221] min, P = 0.86) did not significantly differ between the CE-CT and non-CE-MR groups. |
3 |
| 30. Krishnam MS, Tomasian A, Malik S, et al. Three-dimensional imaging of pulmonary veins by a novel steady-state free-precession magnetic resonance angiography technique without the use of intravenous contrast agent: initial experience. Invest Radiol 2009;44:447-53. |
Observational-Dx |
40 patients |
To evaluate the feasibility of 3-dimensional (3D) steady-state free-precession (SSFP) magnetic resonance angiography (MRA) using nonselective radiofrequency excitation for imaging of pulmonary veins (PVs) without intravenous gadolinium chelate and to correlate the results with conventional contrast-enhanced MRA (CE-MRA). |
On SSFP MRA, readers 1 and 2 graded 96.4% (160/166) and 97% (161/166) of the segments as having diagnostic visibility and sharpness, respectively (k = 0.82). On CE-MRA datasets, all segments were graded as having diagnostic visibility and sharpness by both readers (k = 0.86). No significant difference existed for visibility and sharpness of pulmonary venous segments between the datasets for each reader (P[r] > 0.05). Reader 1 (2) identified 27 (28) and 35 (32) motion artifacts on SSFP and CE-MRA datasets, respectively. No significant difference was found to exist between ostial diameters on CE-MRA and SSFP datasets (P > 0.05). |
3 |
| 31. Pontone G, Andreini D, Bertella E, et al. Comparison of cardiac computed tomography versus cardiac magnetic resonance for characterization of left atrium anatomy before radiofrequency catheter ablation of atrial fibrillation. Int J Cardiol. 179:114-21, 2015 Jan 20. |
Observational-Dx |
400 patients |
To compare the procedural characteristics, overall radiation exposure and clinical outcomes between radiofrequency catheter ablation (RFCA) guided by image integration with cardiac computed tomography (CCT) versus cardiac magnetic resonance (CMR) . |
The 2 groups were homogeneous with similar follow-up (557 ± 302 vs. 523 ± 265 days, respectively, p:0.24). The CCT group showed higher LA volume vs. CMR group (117 ± 46 vs. 101 ± 40 mL, p < 0.001). No differences were observed regarding procedural characteristics. AF recurrence at follow-up was similar (29% vs. 26%, p:0.5) despite a higher radiation exposure in the CCT group vs. CMR group (40.4 ± 23.7 mSv vs. 32.8 ± 23.5 mSv, p < 0.005). LA volume detected by CMR was the most robust independent predictor of AF recurrence at multivariate analysis [(HR: 1.08 (1.01–1.15), p: 0.02]. |
3 |
| 32. Ghafouri K, Franke KB, Foo FS, Stiles MK. Clinical utility of cardiac magnetic resonance imaging to assess the left atrium before catheter ablation for atrial fibrillation - A systematic review and meta-analysis. Int J Cardiol. 339:192-202, 2021 Sep 15. |
Meta-analysis |
24 studies |
This systematic review and meta-analysis aims to clarify the role of pre-procedural cardiac magnetic resonance imaging (MRI) in identifying the association between left atrial (LA) characteristics and post-ablation atrial fibrillation (AF) recurrence. These characteristics include LA fibrosis, emptying function, sphericity, volume, volume index, peak strain and post-contrast T1 relaxation time. |
Twenty-four publications were identified. Every 10% increase in LA fibrosis was associated with a 1.54-fold increase in post-ablation AF recurrence (95%CI: 1.39-1.70, I2 = 50.1%). Every 10 ml increase in LA volume resulted in a hazard ratio of 1.07 (95%CI:1.03-1.12; I2 = 41.4%) for post-ablation AF recurrence. For LA sphericity, there was no significant association with post-ablation AF recurrence (HR: 1.032 [95%CI: 0.962-1.103, I2 = 49.6%). Egger's test was non-significant for publication bias in all meta-analyses. LA volume index, emptying function, peak strain and post-contrast LA T1 relaxation time had insufficient compatible publications to conduct a meta-analysis. |
Good |
| 33. Chubb H, Karim R, Mukherjee R, et al. A comprehensive multi-index cardiac magnetic resonance-guided assessment of atrial fibrillation substrate prior to ablation: Prediction of long-term outcomes. J Cardiovasc Electrophysiol. 30(10):1894-1903, 2019 10. |
Observational-Dx |
89 patients |
To validate and assess the relative contribution of multiple indices in a long-term single-center study. |
Eighty-nine patients (53% paroxysmal AF, 73% male) underwent comprehensive CMR study before first-time AF ablation (median follow-up 726 days [IQR: 418-1010 days]). The 3D late gadolinium-enhanced acquisition (1.5T, 1.3 × 1.3 × 2 mm) was quantified for fibrosis; LA volume and sphericity were assessed on manual segmentation at atrial diastole; LAEF and LVEF were quantified on multislice cine imaging. AF recurred in 43 patients (48%) overall (31 at 1 year). In the recurrence group, LA fibrosis was higher (42% vs 29%; hazard ratio [HR]: 1.032; P = .002), left atrial ejection fraction (LAEF) lower (25% vs 34%; HR: 0.063; P = .016) and LVEF lower (57% vs 63%; HR: 0.011; P = .008). LA volume (135 vs 124 mL) and sphericity (0.819 vs 0.822) were similar. Multivariate Cox regression analysis was adjusted for age and sex (Model 1), additionally AF type (Model 2) and combined (Model 3). In Models 1 and 2, LA fibrosis, LAEF, and LVEF were independently associated with outcome, but only LA fibrosis was independent in Model 3 (HR: 1.021; P = .022). |
3 |
| 34. Csecs I, Yamaguchi T, Kheirkhahan M, et al. Left atrial functional and structural changes associated with ablation of atrial fibrillation - Cardiac magnetic resonance study. Int J Cardiol. 305:154-160, 2020 04 15. |
Observational-Dx |
55 patients |
To detect potential functional and structural predictors of arrhythmia recurrence after ablation using cardiac magnetic resonance imaging (CMRi) and to non-invasively assess the relation between left atrial (LA) functional and structural remodeling pre- and post-ablation. |
Atrial function was lower acutely in patients with recurrence versus those with non-recurrence: [R vs NR: EFTotal 27.8 ± 10.3% vs 38.1 ± 11% p = 0.002; EFActive 10.5 ± 8% vs 19.1 ± 12% p = 0.007; EFPassive 19.4 ± 8 vs 25.8 ± 10 p = 0.021; PLAS 13 ± 5.9% vs 20.2 ± 7% p = 0.004]. With univariate analysis, baseline minimum volume (MinLAV, MinLAVi), several baseline functional parameters (EFTotal, EFPassive, EFActive, PLAS), and LA-LGE were predictors of recurrence [all p < 0.05]. Acute function (EFTotal, EFPassive, EFActive, PLAS) also predicted recurrence (p < 0.01). Lower pre-ablation EFTotal, EFPassive, and PLAS correlated with higher amount of pre-ablation LA-LGE (p < 0.05). In a multivariate model including MinLAV, EFActive and LA-LGE (all at baseline), LA-LGE was the only independent predictor of recurrence (p = 0.0322). |
2 |
| 35. Khurram IM, Habibi M, Gucuk Ipek E, et al. Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF. JACC Cardiovasc Imaging. 9(2):142-8, 2016 Feb. |
Observational-Dx |
165 patients |
The aims of this study were to: 1) use a novel method of late gadolinium enhancement (LGE) quantification that uses normalized intensity measures to confirm the association between LGE extent and atrial fibrillation (AF) recurrence following ablation; and 2) examine the presence of interaction and effect modification between LGE and AF persistence. |
During 10.2 ± 5.7 months of follow-up, 63 patients (38.2%) experienced AF recurrence. Baseline LGE extent was independently associated with AF recurrence after adjusting for confounders (hazard ratio: 1.5 per 10% increased LGE; p < 0.001). The hazard ratio for AF recurrence progressively increased as a function of LGE. The magnitude of association between LGE >35% and AF recurrence was greater among patients with persistent AF (hazard ratio: 6.5 [p = 0.001] vs. 3.6 [p = 0.001]); however, there was no evidence for statistical interaction. |
3 |
| 36. Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 311(5):498-506, 2014 Feb 05. |
Observational-Dx |
329 patients |
To characterize the feasibility of atrial tissue fibrosis estimation by delayed enhancement magnetic resonance imaging (MRI) and its association with subsequent atrial fibrillation (AF) ablation outcome. |
Atrial tissue fibrosis estimation by delayed enhancement MRI was successfully quantified in 272 of 329 enrolled patients (57 patients [17%] were excluded due to poor MRI quality). There were 260 patients who were followed up after the blanking period (mean [SD] age of 59.1 [10.7] years, 31.5% female, 64.6% with paroxysmal AF). For recurrent arrhythmia, the unadjusted overall hazard ratio per 1% increase in left atrial fibrosis was 1.06 (95% CI, 1.03-1.08; P < .001). Estimated unadjusted cumulative incidence of recurrent arrhythmia by day 325 for stage 1 fibrosis was 15.3% (95% CI, 7.6%-29.6%); stage 2, 32.6% (95% CI, 24.3%-42.9%); stage 3, 45.9% (95% CI, 35.5%-57.5%); and stage 4, 51.1% (95% CI, 32.8%-72.2%) and by day 475 was 15.3% (95% CI, 7.6%-29.6%), 35.8% (95% CI, 26.2%-47.6%), 45.9% (95% CI, 35.6%-57.5%), and 69.4% (95% CI, 48.6%-87.7%), respectively. Similar results were obtained after covariate adjustment. The addition of fibrosis to a recurrence prediction model that includes traditional clinical covariates resulted in an improved predictive accuracy with the C statistic increasing from 0.65 to 0.69 (risk difference of 0.05; 95% CI, 0.01-0.09). |
2 |
| 37. Kirstein B, Morris A, Baher A, et al. Magnetic resonance imaging-guided cryoballoon ablation for left atrial substrate modification in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 31(7):1587-1594, 2020 07. |
Observational-Dx |
26 patients |
To report our initial clinical experience of late gadolinium enhancement magnetic resonance imaging (LGE-MRI)-guided left atrial (LA) substrate modification in addition to pulmonary vein isolation (PVI) using cryoballoon ablation (CBA). |
In 26 patients (64?±?11 years, 69% male; 27% persistent AF, CHADSVASC score: 2.3?±?1.5; left ventricular ejection fraction: 56?±?10%, oral anticoagulation with warfarin/direct oral anticoagulants: n?=?11/15), referred for first-time AF ablation, CBA of the pulmonary veins and extrapulmonary LA substrates was performed (median: 12 [interquartile range {IQR}: 7-14] freezes over 1675?seconds [IQR: 1168-2160]). On LGE-MRI, significant postablation cryoballoon-induced LA scar (median: 19.4% [IQR: 13.4-24.7] in comparison to baseline preablation LA-LGE (median: 10.6% [IQR 3.1-13.1]; P?=?.01) was found. Freedom from AF recurrence at 12 months was 74.5% with median time-to-recurrence of 242 days (IQR: 172-298). In 15 of 26 (58%) patients, esophageal enhancement on the postablation MRI was present with full recovery after 3 months. No major periprocedural complications were observed. |
3 |
| 38. Malik R, Alyeshmerni DM, Wang Z, et al. Prevalence and predictors of left atrial thrombus in patients with atrial fibrillation: is transesophageal echocardiography necessary before cardioversion?. Cardiovasc Revasc Med. 16(1):12-4, 2015 Jan-Feb. |
Observational-Dx |
600 patients |
To determine clinical and echocardiographic factors associated with left atrial thrombus (LAT) formation in atrial fibrillation (AF). |
TEE identified LAT in 70 (11.6%) and dense (LA) spontaneous echo contrast (SEC) in 156 (26%). Baseline characteristics and echocardiographic parameters of patients with or without LAT are compared. A prior myocardial infarction, 21 (29.4 %) vs. 31 (5.8), (p < 0.001); hypertension, 60 (85.7%) vs. 386 (72.8), (p 0.02); CHADS(2) = 2, 56 (80%) vs. 308 (58.1%), (p < 0.001) prevalence was higher in patients with LAT. Patients with LAT had lower ejection fraction 38.2 ± 15.6 vs. 46.2 ± 14.5, (p < 0.001); higher LA diameter 4.98 ± 0.7 vs. 4.52 ± 0.7, (p <0.001); dense LA SEC 44 (62.8) vs. 112 (21.1), (p < 0.001); and low LA appendage emptying velocity 21.7 ± 12.9 vs. 37.5 ± 19.4, (p < 0.001). Multivariate analysis was done, and it revealed that low LA emptying velocity had the strongest independent association with LAT (HR 0.89 [CI 0.83-0.96], p value <0.001. |
3 |
| 39. Hwang JJ, Chen JJ, Lin SC, et al. Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations. Am J Cardiol 1993;72:677-81. |
Observational-Dx |
213 patients |
To validate the use of transesophageal echocardiography (TEE) for detecting left atrial (LA) thrombi in a large group of patients with rheumatic heart disease who had undergone mitral valve operations. |
Of the 213 patients, 147 had predominant mitral stenosis, and the remaining 66 patients had significant mitral regurgitation. Twenty-eight patients had LA thrombi by TEE criteria. These findings were all confirmed at surgicopathologic studies (specificity 100%). However, in 2 patients, LA thrombi were present but could not be detected by TEE (sensitivity 93.3%). Therefore, the positive predictive value was 100%, the negative predictive value was 98.9% and the diagnostic accuracy was 99.1%. No thrombi were found in patients with significant mitral regurgitation. The frequency of LA thrombi in patients with predominant mitral stenosis was 20% (30 of 147), and most of these patients had chronic atrial fibrillation (28 of 30, 93%). Only 16 patients (16 of 30, 53%) were found to have LA thrombi by transthoracic echocardiography. Furthermore, our data showed poor correlation between the echogenicity of LA thrombi and the degree of thrombus organization. |
2 |
| 40. Manning WJ, Weintraub RM, Waksmonski CA, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med 1995;123:817-22. |
Observational-Dx |
231 patients |
To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi. |
Transesophageal echocardiography identified 14 left atrial thrombi in 14 patients (6%). Thrombus size range from 3 to 80 mm. Surgery confirmed 12 of 14 thrombi (86%), including 9 thrombi confined to the left appendage. No additional thrombi were found on direct inspection of the atria (sensitivity, 100% [95% CI, 74% to 100%]; specificity, 99% [CI, 97% to 99.9%]; positive predictive value, 86% [12/14]; negative predictive value, 100% [217/217]; for a population that had a 5.2% prevalence of thrombi). All 12 surgically confirmed thrombi were identified by two independent observers. Neither thrombus seen by only a single observer on transesophageal echocardiography was confirmed during direct inspection of the atria at surgery. |
1 |
| 41. Ayirala S, Kumar S, O'Sullivan DM, Silverman DI. Echocardiographic predictors of left atrial appendage thrombus formation. J Am Soc Echocardiogr. 24(5):499-505, 2011 May. |
Observational-Dx |
334 patients |
The authors hypothesized that higher left atrial (LA) volume and/or lower left ventricular ejection fraction (LVEF) might prove valuable as markers of increased risk for LA appendage thrombus formation and tested this hypothesis in a consecutive retrospective series of patients with atrial fibrillation undergoing both transthoracic and transesophageal echocardiography. |
LA appendage thrombus was detected in 52 patients (15.6%). A higher CHADS(2) score (odds ratio, 1.45; P < .004), increased LA volume index (odds ratio, 1.02; P = .018), and lower LVEF (odds ratio, 1.02; P = .05) were significant predictors of LA appendage thrombus formation. LA appendage thrombus was not seen in patients with CHADS(2) scores = 1, LVEFs > 55%, and a LA volume indexes < 28 mL/m(2). A ratio of LVEF to LA volume index = 1.5 produced 100% sensitivity for the presence of LA appendage thrombus. |
2 |
| 42. Anaissie J, Monlezun D, Seelochan A, et al. Left Atrial Enlargement on Transthoracic Echocardiography Predicts Left Atrial Thrombus on Transesophageal Echocardiography in Ischemic Stroke Patients. Biomed Res Int. 2016:7194676, 2016. |
Observational-Dx |
219 patients |
To determine the utility of using left atrial enlargement (LAE) on transesophageal echocardiogram (TEE) to predict left atrial thrombus (LAT) on TEE. |
219 AIS patients underwent both TTE and TEE. LAE on TTE was detected in 113 (51.6%) of AIS patients. Patients with LAE on TTE had higher proportion of LAT on TEE (8.4% versus 1.0%, p = 0.018). LAE on TTE predicted increased odds of LAT on TEE (OR = 8.83, 95% CI 1.04–74.83, p = 0.046). The sensitivity and specificity for LAT on TEE by LAE on TEE were 88.89% and 52.20%, respectively (AUC = 0.7054, 95% CI 0.5906–0.8202). Conclusions. LAE on TTE can predict LAT detected on TEE in nearly 90% of patients. This demonstrates the utility of LAE on TTE as a potential screening tool for LAT, potentially limiting unneeded costs and complications associated with TEE. |
2 |
| 43. Eng MH, Wang DD, Greenbaum AB, et al. Prospective, randomized comparison of 3-dimensional computed tomography guidance versus TEE data for left atrial appendage occlusion (PRO3DLAAO). Catheter Cardiovasc Interv 2018;92:401-07. |
Observational-Dx |
24 patients |
To conduct a pilot study comparing 3-dimensional computed tomography (3D-CT) to transesophageal echocardiography (TEE) in occluder selection accuracy and procedural efficiency. |
Procedure success was 100% and 92% for the 3D-CT and 2D-TEE cohorts respectively. Accuracy for 1st device selection 92% and 27% (P = .01) for 3D-CT and 2D-TEE respectively but with intra-procedural upsizing in the 2D-TEE cohort, the 2D-TEE cohort accuracy increased to 64% while the 3D-CT groups 92% was accurate (P = .33). Case planning using 3D-CT was significantly more efficient with respect to device utilization (CT 1.33 ± 0.7 vs. 2D-TEE 2.5 ± 1.2 P = .01), guide catheters (CT 1 vs. 2D-TEE 1.7 ± 0.8 P = .01) and procedure time (3D-CT 55 ± 17 min vs. 2D-TEE 73 ± 24 min P < .05). One major adverse event, a stroke occurred in the 2D-TEE group. |
2 |
| 44. Bai W, Chen Z, Tang H, Wang H, Cheng W, Rao L. Assessment of the left atrial appendage structure and morphology: comparison of real-time three-dimensional transesophageal echocardiography and computed tomography. Int J Cardiovasc Imaging. 33(5):623-633, 2017 May. |
Observational-Dx |
251 patients |
To compare the left atrial appendage (LAA) morphology and size of Chinese nonvalvular atrial fibrillation (NVAF) patients as determined using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) and computed tomography (CT). |
Two hundred nonvalvular atrial fibrillation (NVAF) patients who were prepared to undergo radiofrequency ablation were enrolled, and 62 controls were enrolled prospectively. RT3D-TEE and CT were performed, and the following parameters were measured: LAA orifice diameter, area, depth, maximum volume, and emptying velocity. The differences between the NVAF patients and controls were compared, and the differences and correlations in the LAA parameters between the two imaging techniques were assessed. The NVAF patients had significantly bigger orifice sizes, orifice areas, and maximum volumes, and lower emptying rates. The AF cohort had roughly equal proportions of the four morphological types, whereas the controls predominantly had the windsock type. A Bland–Altman analysis demonstrated that the LAA measurements obtained using RT3D-TEE were lower than those obtained with the CT. However, linear regression analysis showed the good correlations between the RT3D-TEE and CT measurements of the LAA orifice area, depth and volume (r = 0.86, 0.63, and 0.75, respectively). The use of RT3D-TEE for the visualization and quantitative analysis of LAA parameters is feasible, and the obtained measurements correlate well with those obtained with cardiac CT. This technique may be an ideal tool for guiding LAA occlusion procedures, and combining these two methods may enhance the accuracy of LAA measurements. |
3 |
| 45. Saw J, Fahmy P, Spencer R, et al. Comparing Measurements of CT Angiography, TEE, and Fluoroscopy of the Left Atrial Appendage for Percutaneous Closure. J Cardiovasc Electrophysiol. 27(4):414-22, 2016 Apr. |
Observational-Dx |
50 patients |
To report our experience of using comparing measurements of CT angiography (CCTA) preprocedure for left atrial appendage (LAA) closure for device selection and sizing. |
We report 50 consecutive patients who underwent LAA closure (8 ACP, 10 Amulet, 32 WATCHMAN). Average age was 75.2 ± 8.7 years, mean CHADS2 score 3.0 ± 1.3, and CHA2 DS2 -VASc 4.7 ± 1.5. Procedural device implantation success was 100%. For ACP landing zone, mean maximal measurements were 24.1 ± 4.7 mm with CCTA, 22.3 ± 4.9 mm TEE, and 19.9 ± 5.6 mm fluoroscopy (P < 0.001); R value 0.81 fluoroscopy/CTA, 0.67 fluoroscopy/TEE, and 0.80 CTA/TEE. For WATCHMAN ostium, mean maximal measurements were 25.8 ± 4.7 mm CCTA (P < 0.001 vs. fluoroscopy, P = 0.16 vs. TEE), 25.1 ± 4.4 mm TEE (P = 0.016 vs. fluoroscopy), and 23.8 ± 4.9 mm fluoroscopy; R value 0.71 fluoroscopy/CTA, 0.65 fluoroscopy/TEE, and 0.74 CTA/TEE. Depth measurements were 34.3 ± 5.7 mm with CCTA, 31.1 ± 6.5 mm TEE, and 27.8 ± 7.1 mm fluoroscopy (all P < 0.01); and correlations with R value 0.28 fluoroscopy/CTA, 0.22 fluoroscopy/TEE, and 0.56 CTA/TEE. |
3 |
| 46. Wang DD, Eng M, Kupsky D, et al. Application of 3-Dimensional Computed Tomographic Image Guidance to WATCHMAN Implantation and Impact on Early Operator Learning Curve: Single-Center Experience. JACC Cardiovasc Interv 2016;9:2329-40. |
Observational-Dx |
53 patients |
To examine the impact of 3-dimensional (3D) computed tomographic (CT) guided procedural planning for left atrial appendage (LAA) occlusion on the early operator WATCHMAN learning curve. |
All 53 patients underwent successful LAA occlusion with the WATCHMAN. Three-dimensional CT LAA maximal-width sizing was 2.7 ± 2.2 mm and 2.3 ± 3.0 mm larger than 2-dimensional and 3D TEE measurements, respectively (p = 0.0001). By CT imaging, device selection was 100% accurate. There were 4 peri-WATCHMAN leaks (<4.5 mm) secondary to accessory LAA pedunculations. By 2-dimensional TEE maximal-width measurements alone, 62.3% (33 of 53) would have required larger devices. Using 3D TEE maximal-width measurements, 52.8% of cases (28 of 53) would have required larger devices. Three-dimensional TEE length would have inappropriately excluded 10 patients from WATCHMAN implantation. Compared with the average of 1.8 devices used per implantation attempt in PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) (82% success rate), the present site averaged 1.245 devices per implantation attempt (100% success rate). There were no intraprocedural screen failures and no major adverse cardiac events. |
3 |
| 47. So CY, Kang G, Villablanca PA, et al. Additive Value of Preprocedural Computed Tomography Planning Versus Stand-Alone Transesophageal Echocardiogram Guidance to Left Atrial Appendage Occlusion: Comparison of Real-World Practice. J Am Heart Assoc. 10(17):e020615, 2021 09 07. |
Observational-Dx |
485 patients |
To assess the additive value of preprocedural computed tomography (CT) planning versus stand-alone transesophageal echocardiogram (TEE) imaging guidance to left atrial appendage (LAA) occlusion (LAAO). |
We retrospectively reviewed 485 Watchman implantations at a single center to compare the outcomes of using additional CT preprocedural planning (n=328, 67.6%) versus stand-alone transesophageal echocardiogram guidance (n=157, 32.4%) for left atrial appendage occlusion. The primary end point was the rate of successful device implantation without major peri-device leak (>5 mm). Secondary end points included major adverse events, total procedural time, delivery sheath and devices used, risk of major peri-device leak and device-related thrombus at follow-up imaging. A single/anterior-curve delivery sheath was used more commonly in those who underwent CT imaging (35.9% versus 18.8%; P<0.001). Additional preprocedural CT planning was associated with a significantly higher successful device implantation rate (98.5% versus 94.9%; P=0.02), a shorter procedural time (median, 45.5 minutes versus 51.0 minutes; P=0.03) and a less frequent change of device size (5.6% versus 12.1%; P=0.01), particularly device upsize (4% versus 9.4%; P=0.02). However, there was no significant difference in the risk of major adverse events (2.1% versus 1.9%; P=0.87). Only 1 significant peri-device leak (0.2%) and 5 device-related thrombi were detected in follow-up (1.2%) with no intergroup difference. |
3 |
| 48. Romero J, Husain SA, Kelesidis I, Sanz J, Medina HM, Garcia MJ. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: a meta-analysis. [Review]. Circ Cardiovasc Imaging. 6(2):185-94, 2013 Mar 01. |
Meta-analysis |
19 studies with 2955 patients |
To evaluate the diagnostic accuracy of cardiac computed tomography assessing left atrial/LA appendage (LA/LAA) thrombi in comparison with transesophageal echocardiogram (TEE) . |
Nineteen studies with 2955 patients (men, 71%; mean age, 61±4 years) fulfilled the inclusion criteria. Most studies (85%, 16 studies) used 64-slide multidetector computed tomography and 15 studies (79%) were electrocardiographic-gated. The incidence of LA/LAA thrombi was 8.9% (SD, ±7). The mean sensitivity and specificity were 96% and 92%, whereas the positive predictive value and negative predictive value were 41% and 99%, respectively. The diagnostic accuracy was 94%. In a subanalysis of studies in which delayed imaging was performed, the diagnostic accuracy significantly improved to a mean weighted sensitivity and specificity of 100% and 99%, respectively, whereas the positive predictive value and negative predictive value increased to 92% and 100%, respectively. The accuracy for this technique was 99%. |
Good |
| 49. Chow DH, Bieliauskas G, Sawaya FJ, et al. A comparative study of different imaging modalities for successful percutaneous left atrial appendage closure. Open Heart 2017;4:e000627. |
Observational-Dx |
67 patients |
To compare different left atrial appendage (LAA) imaging modalities and sizing methods in order to obtain successful LAA closure. |
The study population (n=67) had a mean CHA2DS2-VASc score of 3.0 and HAS-BLED score of 2.7. Fifty-eight patients (87%) were identified to have successful LAA closure. Based on MSCT, 48 LAA sizings (83%) resulted in a correct LAA closure device size selection, whereas with 2D-TEE sizing, only 33 measurements (57%) would have resulted in a correct device size selection (p<0.01). Using adapted Bland-Altman method, MSCT-based perimeter-derived mean diameter was shown to be the best parameter to guide LAA device size selection for ‘closed-end’ devices (Amulet, WatchmanFLX), whereas the maximal diameter was the best parameter for the ‘open-end’ Watchman device. |
3 |
| 50. Rathi VK, Reddy ST, Anreddy S, et al. Contrast-enhanced CMR is equally effective as TEE in the evaluation of left atrial appendage thrombus in patients with atrial fibrillation undergoing pulmonary vein isolation procedure. Heart Rhythm. 10(7):1021-7, 2013 Jul. |
Observational-Dx |
97 patients |
To hypothesize that a retrospective comparison of 2-dimensional/3-dimensional (2D/3D) contrast-enhanced cardiac magnetic resonance (CMR) sequences with transesophageal echocardiography (TEE) for the evaluation of left atrial appendage (LAA) thrombus in patients with left atrial appendage (LAA) selected for pulmonary vein isolation (PVI) will demonstrate equivalence. |
All subjects were analyzed for the presence or absence of LAA thrombus. Thrombus was absent in 98% of the patients on both TEE and CMR and present in 2% on both studies (100% correlation). In 6 subjects, 2D cine CMR images were indeterminate whereas all 2D early gadolinium enhancement images and 3D contrast images were successful in excluding LAA thrombus. There was 100% concordance between CMR and TEE for the final diagnosis of LAA thrombus. |
2 |
| 51. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016;18:1609-78. |
Review/Other-Dx |
N/A |
To discuss European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation develop in collaboration with European Association for Cardio-Thoracic Surgery (EACTS). |
No abstract available. |
4 |
| 52. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
