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Prone-position computed tomography in the late phase for detecting intracardiac thrombi in the left atrial appendage before catheter ablation for atrial fibrillation
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  • Rena Nakamura,
  • Atsuhito Oda,
  • Shinichi Tachibana,
  • Koji Sudo,
  • Takatoshi Shigeta,
  • Yuichiro Sagawa,
  • Manabu Kurabayashi,
  • Masahiko Goya,
  • Kaoru Okishige,
  • Tetsuo Sasano,
  • Yasuteru Yamauchi
Rena Nakamura
Japan Red Cross Yokohama-city Bay Hospital
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Atsuhito Oda
Japan Red Cross Yokohama City Bay Hospital
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Shinichi Tachibana
Yokohama City Minato Red Cross Hospital
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Koji Sudo
Japan Red Cross Yokohama City Bay Hospital
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Takatoshi Shigeta
Yokohama Bay Red Cross Hospital
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Yuichiro Sagawa
Yokosuka Kyousai Hospital
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Manabu Kurabayashi
Yokohama-city Port Red Cross Hospital
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Masahiko Goya
Tokyo Medical and Dental University Hospital
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Kaoru Okishige
Yokohama-city Port Red Cross Hospital
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Tetsuo Sasano
Tokyo Medical and Dental University
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Yasuteru Yamauchi
Yokohama-city Bay Red Cross Hospital
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Abstract

Background: Contrast computed tomography (CT) is a useful tool for the detection of intracardiac thrombi. We aimed to assess the accuracy of the late-phase prone-position contrast CT (late-pCT) for thrombus detection in patients with persistent or long-standing persistent atrial fibrillation (AF). Methods: Early and late-phase pCT were performed in 300 patients with persistent or long-standing AF. If late-pCT did not show an intracardiac contrast defect (CD), catheter ablation (CA) was performed. Immediately prior to CA, intracardiac echocardiography (ICE) from the left atrium was performed to confirm thrombus absence and the estimation of the blood velocity of the left atrial appendage (LAA). For patients with CDs on late-pCT, CA performance was delayed, and late-pCT was performed again after several months following oral anticoagulant alterations or dosage increases. Results: Of the 40 patients who exhibited CDs in the early phase of pCT, six showed persistent CDs on late-pCT. In the remaining 294 patients without CDs on late-pCT, the absence of a thrombus was confirmed by ICE during CA. In all six patients with CD-positivity on late-pCT, the CDs vanished under the same CT conditions after subsequent anticoagulation therapy, and CA was successfully performed. Furthermore, the presence of residual contrast medium in the LAA on late-pCT suggested a decreased blood velocity in the LAA (≤ 15 cm/s) (sensitivity = 0.900 and specificity = 0.621). Conclusions: Late-pCT is a valuable tool for the assessment of intracardiac thrombi and LAA dysfunction in patients with persistent or long-standing persistent AF before CA.

Peer review status:ACCEPTED

27 Jan 2021Submitted to Journal of Cardiovascular Electrophysiology
01 Feb 2021Submission Checks Completed
01 Feb 2021Assigned to Editor
04 Feb 2021Reviewer(s) Assigned
02 Mar 2021Review(s) Completed, Editorial Evaluation Pending
03 Mar 2021Editorial Decision: Revise Minor
06 Mar 20211st Revision Received
15 Mar 2021Submission Checks Completed
15 Mar 2021Assigned to Editor
15 Mar 2021Reviewer(s) Assigned
28 Mar 2021Review(s) Completed, Editorial Evaluation Pending
30 Mar 2021Editorial Decision: Accept