ArticlePacing and clinical electrophysiology : PACE2018
The use of cardiac-CT alone to exclude left atrial thrombus before atrial fibrillation ablation: Efficiency, safety, and cost analysis.
Article in Pacing and clinical electrophysiology : PACE, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Inpatient cardiac computed tomography angiography in Germany between 2005 and 2023: a nationwide registry study.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- [Guideline to safe and effective atrial fibrillation ablation with pulsed-field ablation using the pentaspline PFA system as an example].Herzschrittmachertherapie & Elektrophysiologie · 2025Article
- The Imaging Evaluation of Left Atrial Appendage: CT Large-Spiral Arterial Late Scan.International journal of general medicine · 2025Article
- Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation-An 11-Year Experience from an Academic Emergency Department.Diagnostics (Basel, Switzerland) · 2024Article
- The effect of two different methods of planning landing zone for left atrial appendage closure by cardiac computed tomography angiography: a comparative study.Annals of translational medicine · 2023Article
- From Bench to Bedside-Implementing the New ABC Approach for Atrial Fibrillation in an Emergency Department Setting.International journal of environmental research and public health · 2022Article
- [Acute and chronic cardiac involvement in COVID-19].Der Radiologe · 2021Review
- Left atrial appendage occlusion using intracardiac echocardiography.Heart rhythm · 2021Review
- The differences of atrial thrombus locations and variable response to anticoagulation in nonvalvular atrial fibrillation with ventricular cardiomyopathy.Journal of arrhythmia · 2020Article
- Cardiac imaging procedures and the COVID-19 pandemic: recommendations of the European Society of Cardiovascular Radiology (ESCR).The international journal of cardiovascular imaging · 2020Review
- Statement from the North American Society for Cardiovascular Imaging on imaging strategies to reduce the scarcity of healthcare resources during the COVID-19 outbreak.The international journal of cardiovascular imaging · 2020Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundAtrial fibrillation (AF) is a growing financial burden on the healthcare system. Cardiac computed tomographic angiography (CCTA) is needed for pulmonary vein mapping before AF ablation (AFA). CCTA has shown to be an alternative to transesophageal echocardiogram (TEE) to rule out left atrial appendage thrombus (LAAT) pre-AFA. We aim to examine the safety, cost-effectiveness, and time-efficiency of utilizing CCTA alone to rule out LAAT before AFA.
methodsWe prospectively screened patients with paroxysmal AF undergoing cryoablation. CCTA with delayed enhancement was performed within 72 hours of AFA. Once LAAT was ruled out, patients were enrolled and planned TEE was cancelled. A retrospective control cohort that had both CCTA and TEE prior to AFA was identified. Direct cost data, electrophysiology laboratory utilization time, and 30-day stroke outcomes were collected from the EMR, follow-up phone calls, or clinic visits, and comparative analyses were performed.
resultsSeventy patients met the inclusion criteria in the prospective CCTA-only cohort, and 71 for the retrospective CCTA+TEE cohort. Baseline characteristics were similar between the two groups. There was a nonsignificant reduction in overall cost ($15,870 ± 1,710 vs $16,557 ± 2,508, P = 0.06) in CCTA-only cohort, whereas the electrophysiology laboratory utilization time was significantly reduced (241.6 ± 41.7 vs 181.3 ±36.4 minutes, P < 0.001). There were no strokes reported on 30-day follow-up in the CCTA-only group.
conclusionsIn low-to-intermediate stroke risk patients with paroxysmal AF undergoing cryoablation, eliminating TEE and employing CCTA-only strategy to rule-out LAAT improves electrophysiology laboratory efficiency without influencing periprocedural cost or increasing postprocedural stroke risk.
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