Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department
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 ye...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/7/699 |
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| author | Sophie Gupta Martin Lutnik Filippo Cacioppo Teresa Lindmayr Nikola Schuetz Elvis Tumnitz Lena Friedl Magdalena Boegl Sebastian Schnaubelt Hans Domanovits Alexander Spiel Daniel Toth Raoul Varga Marcus Raudner Harald Herkner Michael Schwameis Jan Niederdoeckl |
| author_facet | Sophie Gupta Martin Lutnik Filippo Cacioppo Teresa Lindmayr Nikola Schuetz Elvis Tumnitz Lena Friedl Magdalena Boegl Sebastian Schnaubelt Hans Domanovits Alexander Spiel Daniel Toth Raoul Varga Marcus Raudner Harald Herkner Michael Schwameis Jan Niederdoeckl |
| author_sort | Sophie Gupta |
| collection | DOAJ |
| description | 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 CHA<sub>2</sub>DS<sub>2</sub>-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 CHA<sub>2</sub>DS<sub>2</sub>-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. |
| first_indexed | 2024-04-24T10:48:18Z |
| format | Article |
| id | doaj.art-d8faeae9505e4642871f676ae5977d08 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-04-24T10:48:18Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-d8faeae9505e4642871f676ae5977d082024-04-12T13:16:43ZengMDPI AGDiagnostics2075-44182024-03-0114769910.3390/diagnostics14070699Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency DepartmentSophie Gupta0Martin Lutnik1Filippo Cacioppo2Teresa Lindmayr3Nikola Schuetz4Elvis Tumnitz5Lena Friedl6Magdalena Boegl7Sebastian Schnaubelt8Hans Domanovits9Alexander Spiel10Daniel Toth11Raoul Varga12Marcus Raudner13Harald Herkner14Michael Schwameis15Jan Niederdoeckl16Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Clinic Ottakring, Vienna Healthcare Group, 1160 Vienna, AustriaDepartment of Radiology, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Radiology, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Radiology, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, 1090 Vienna, AustriaBackground: 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 CHA<sub>2</sub>DS<sub>2</sub>-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 CHA<sub>2</sub>DS<sub>2</sub>-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.https://www.mdpi.com/2075-4418/14/7/699cardioversionleft atrial appendage thrombusatrial fibrillationemergency medicine |
| spellingShingle | Sophie Gupta Martin Lutnik Filippo Cacioppo Teresa Lindmayr Nikola Schuetz Elvis Tumnitz Lena Friedl Magdalena Boegl Sebastian Schnaubelt Hans Domanovits Alexander Spiel Daniel Toth Raoul Varga Marcus Raudner Harald Herkner Michael Schwameis Jan Niederdoeckl Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department Diagnostics cardioversion left atrial appendage thrombus atrial fibrillation emergency medicine |
| title | Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department |
| title_full | Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department |
| title_fullStr | Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department |
| title_full_unstemmed | Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department |
| title_short | Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation—An 11-Year Experience from an Academic Emergency Department |
| title_sort | computed tomography to exclude cardiac thrombus in atrial fibrillation an 11 year experience from an academic emergency department |
| topic | cardioversion left atrial appendage thrombus atrial fibrillation emergency medicine |
| url | https://www.mdpi.com/2075-4418/14/7/699 |
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