Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department

Author:

Gupta Sophie1,Lutnik Martin2,Cacioppo Filippo1ORCID,Lindmayr Teresa1,Schuetz Nikola1,Tumnitz Elvis1,Friedl Lena1,Boegl Magdalena13,Schnaubelt Sebastian1ORCID,Domanovits Hans1ORCID,Spiel Alexander4ORCID,Toth Daniel5,Varga Raoul5ORCID,Raudner Marcus5,Herkner Harald1ORCID,Schwameis Michael1ORCID,Niederdoeckl Jan12ORCID

Affiliation:

1. Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria

2. Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria

3. Clinical Division of Gynaecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria

4. Department of Emergency Medicine, Clinic Ottakring, Vienna Healthcare Group, 1160 Vienna, Austria

5. Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria

Abstract

Background: Computed tomography (CT) could be a suitable method for acute exclusion of left atrial appendage thrombus (LAAT) prior to cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) at the emergency department. Our aim was to present our experiences with this modality in recent years. Methods: This registry-based observational study was performed at the Department of Emergency Medicine at the Medical University of Vienna, Austria. We studied all consecutive patients with AF and AFL who underwent CT between January 2012 and January 2023 to rule out LAAT before cardioversion to sinus rhythm was attempted. Follow-ups were conducted by telephone and electronic medical records. The main variables of interest were the rate of LAAT and ischemic stroke at follow-up. Results: A total of 234 patients (143 [61%] men; median age 68 years [IQR 57–76], median CHA2DS2-VASc 2 [IQR 1–4]) were analyzed. Follow-up was completed in 216 (92%) patients after a median of 506 (IQR 159–1391) days. LAAT was detected in eight patients (3%). A total of 163 patients (72%) in whom LAAT was excluded by CT were eventually successfully cardioverted to sinus rhythm. No adverse events occurred during their ED stay. All patients received anticoagulation according to the CHA2DS2-VASc risk stratification, and no patient had suffered an ischemic stroke at follow-up, resulting in an incidence risk of ischemic strokes of 0% (95% CI 0.0–1.2%). Conclusion: LAAT was rare in patients admitted to the ED with AF and AFL who underwent cardiac CT prior to attempted cardioversion. At follow-up, no patient had suffered an ischemic stroke. Prospective studies need to show whether this strategy is suitable for the acute treatment of symptomatic AF in the emergency setting.

Publisher

MDPI AG

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3