Diagnostic accuracy of arterial phase 64-slice multidetector CT angiography for left atrial appendage thrombus in patients undergoing atrial fibrillation ablation

Ilan Gottlieb, Aurélio Pinheiro, Jeff A. Brinker, Mary C. Corretti, Susan A. Mayer, David A. Bluemke, Joao A C Lima, Joseph E. Marine, Ronald D. Berger, Hugh Calkins, Theodore P. Abraham, Charles Henrikson

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

MDCT for LA Thrombus Assessment. Introduction: Multidetector CT (MDCT) is used prior to atrial fibrillation ablation (AFA) to anatomically guide ablation procedures. Whether 64-slice MDCT also can be used to diagnose left atrial thrombus is not known. Methods: We sought to determine the accuracy and interobserver variability of MDCT in the evaluation of left atrial thrombus prior to AFA. We enrolled 50 patients scheduled for AFA who underwent 64-slice MDCT scan and transesophageal echocardiography prior to the procedure. Three experienced observers reviewed all the MDCT images for the presence of a left atrial thrombus, and two different readers interpreted the transesophageal echocardiograms (TEE), which were used as the gold standard. All observers were blinded to clinical data and each other. Results: Interobserver variability between the three MDCT readers was poor (highest kappa statistic 0.43, P = 0.001). Diagnostic accuracy was highly variable, with sensitivities ranging from 100% to 50% and specificities ranging from 85% to 44%. TEE reader agreement was 98%. Conclusion: MDCT demonstrates high interobserver variability and has only modest diagnostic accuracy for the detection of left atrial thrombus in patients undergoing AFA procedure. Potential factors affecting the accuracy of MDCT include image quality and the difficulty of distinguishing clot from pectinate muscle. MDCT likely is not the optimal method to detect left atrial thrombus using current techniques and standards of interpretation.

Original languageEnglish (US)
Pages (from-to)247-251
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume19
Issue number3
DOIs
StatePublished - Mar 2008
Externally publishedYes

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Atrial Appendage
Atrial Fibrillation
Thrombosis
Observer Variation
Transesophageal Echocardiography
Computed Tomography Angiography
Muscles

Keywords

  • Atrial fibrillation ablation
  • Diagnostic test
  • Left atrial thrombus
  • Multidetector computed tomography
  • Transesophageal echocardiogram

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Diagnostic accuracy of arterial phase 64-slice multidetector CT angiography for left atrial appendage thrombus in patients undergoing atrial fibrillation ablation. / Gottlieb, Ilan; Pinheiro, Aurélio; Brinker, Jeff A.; Corretti, Mary C.; Mayer, Susan A.; Bluemke, David A.; Lima, Joao A C; Marine, Joseph E.; Berger, Ronald D.; Calkins, Hugh; Abraham, Theodore P.; Henrikson, Charles.

In: Journal of Cardiovascular Electrophysiology, Vol. 19, No. 3, 03.2008, p. 247-251.

Research output: Contribution to journalArticle

Gottlieb, Ilan ; Pinheiro, Aurélio ; Brinker, Jeff A. ; Corretti, Mary C. ; Mayer, Susan A. ; Bluemke, David A. ; Lima, Joao A C ; Marine, Joseph E. ; Berger, Ronald D. ; Calkins, Hugh ; Abraham, Theodore P. ; Henrikson, Charles. / Diagnostic accuracy of arterial phase 64-slice multidetector CT angiography for left atrial appendage thrombus in patients undergoing atrial fibrillation ablation. In: Journal of Cardiovascular Electrophysiology. 2008 ; Vol. 19, No. 3. pp. 247-251.
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AU - Gottlieb, Ilan

AU - Pinheiro, Aurélio

AU - Brinker, Jeff A.

AU - Corretti, Mary C.

AU - Mayer, Susan A.

AU - Bluemke, David A.

AU - Lima, Joao A C

AU - Marine, Joseph E.

AU - Berger, Ronald D.

AU - Calkins, Hugh

AU - Abraham, Theodore P.

AU - Henrikson, Charles

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N2 - MDCT for LA Thrombus Assessment. Introduction: Multidetector CT (MDCT) is used prior to atrial fibrillation ablation (AFA) to anatomically guide ablation procedures. Whether 64-slice MDCT also can be used to diagnose left atrial thrombus is not known. Methods: We sought to determine the accuracy and interobserver variability of MDCT in the evaluation of left atrial thrombus prior to AFA. We enrolled 50 patients scheduled for AFA who underwent 64-slice MDCT scan and transesophageal echocardiography prior to the procedure. Three experienced observers reviewed all the MDCT images for the presence of a left atrial thrombus, and two different readers interpreted the transesophageal echocardiograms (TEE), which were used as the gold standard. All observers were blinded to clinical data and each other. Results: Interobserver variability between the three MDCT readers was poor (highest kappa statistic 0.43, P = 0.001). Diagnostic accuracy was highly variable, with sensitivities ranging from 100% to 50% and specificities ranging from 85% to 44%. TEE reader agreement was 98%. Conclusion: MDCT demonstrates high interobserver variability and has only modest diagnostic accuracy for the detection of left atrial thrombus in patients undergoing AFA procedure. Potential factors affecting the accuracy of MDCT include image quality and the difficulty of distinguishing clot from pectinate muscle. MDCT likely is not the optimal method to detect left atrial thrombus using current techniques and standards of interpretation.

AB - MDCT for LA Thrombus Assessment. Introduction: Multidetector CT (MDCT) is used prior to atrial fibrillation ablation (AFA) to anatomically guide ablation procedures. Whether 64-slice MDCT also can be used to diagnose left atrial thrombus is not known. Methods: We sought to determine the accuracy and interobserver variability of MDCT in the evaluation of left atrial thrombus prior to AFA. We enrolled 50 patients scheduled for AFA who underwent 64-slice MDCT scan and transesophageal echocardiography prior to the procedure. Three experienced observers reviewed all the MDCT images for the presence of a left atrial thrombus, and two different readers interpreted the transesophageal echocardiograms (TEE), which were used as the gold standard. All observers were blinded to clinical data and each other. Results: Interobserver variability between the three MDCT readers was poor (highest kappa statistic 0.43, P = 0.001). Diagnostic accuracy was highly variable, with sensitivities ranging from 100% to 50% and specificities ranging from 85% to 44%. TEE reader agreement was 98%. Conclusion: MDCT demonstrates high interobserver variability and has only modest diagnostic accuracy for the detection of left atrial thrombus in patients undergoing AFA procedure. Potential factors affecting the accuracy of MDCT include image quality and the difficulty of distinguishing clot from pectinate muscle. MDCT likely is not the optimal method to detect left atrial thrombus using current techniques and standards of interpretation.

KW - Atrial fibrillation ablation

KW - Diagnostic test

KW - Left atrial thrombus

KW - Multidetector computed tomography

KW - Transesophageal echocardiogram

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