Computed tomography in the left lateral decubitus position before catheter ablation in patients with atrial fibrillation

Bakhytovich K.B. Ibzhanovna R.R. Evgenyevich S.V. Bekpolatovich D.T. Suleimenovich A.A.
2023 Limited Liability Company KlinMed Consulting

Kardiologiya
2023 #63 Issue 6 61 - 68 pp.

Aim The study aimed to determine the efficacy of cardiac computed tomography angiography (CCTA) for diagnosing left atrial appendage (LAA) thrombus before catheter ablation with the patient in the left lateral decubitus position and, also, to evaluate the risk factors for thrombus formation. Material and methods This retrospective, cohort study included 101 patients with atrial fibrillation. All patients underwent transthoracic echocardiography (TTE) and left lateral decubitus CCTA. Transesophageal echocardiography (TEE) was performed to confirm or exclude LAA thrombus. Patients with allergic reactions to iodinated contrast media, increased serum creatinine, hyperthyroidism, pregnancy, and age<18 years were excluded. The CHA₂‑DS₂‑VASc and HAS‑BLED scores were calculated for each patient. Results All LAA thrombi detected on CCTA were confirmed by TEE. Higher CHA₂‑DS₂‑VASc, HAS‑BLED scores, enlarged LA, and the anteroposterior dimension of the left atrium were significantly associated with the presence of LAA thrombus. A LAA cauliflower shape was a predictor of thrombus. An increase of LAA volume by 1 ml increased the chances of LAA thrombus and cerebral ischemic infarct by 2%. The growth of the LAA anteroposterior diameter by 1 cm increased the risk of LAA thrombus by 190% and of cerebral infarct by 78%. An increase in the CHA₂DS₂‑VASc score by 1 point increased the risk of thromboembolism and cerebral infarction by 12%. Conclusions CCTA performed in the left lateral decubitus position of the patient is an optimal screening tool to detect or exclude LAA thrombus before catheter ablation because of atrial fibrillation. CCTA has predictive value for risk of thrombosis formation in LAA.

atrial fibrillation , Computed tomography , echocardiography , left atrial appendage thrombosis

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National Research Cardiac Surgery Center, Department of Interventional Cardiology and Radiology, Ministry of Health of The Kazakhstan, Astana, Kazakhstan
JSC, Astana Medical University, Department of Radiology No. 1, Astana, Kazakhstan
Moscow Lomonosov State University, Department of Radiology, Moscow, Russian Federation

National Research Cardiac Surgery Center
JSC
Moscow Lomonosov State University

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