Transe-Esophageal Echocardiography Is Not Required in All Patients before Pulmonary Vein Isolation

概要

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Trans-esophageal echocardiography <TEE> has been recognized as a standard procedure to exclude left atrial appendage thrombus <LAA-T>, but it may cause discomfort in some patients. Multi-detector computed tomography <MDCT> may be performed to understand PV and LA anatomy as well as to detect LAA-T in patients with atrial fibrillation <AF>. The purpose of this study is to determine whether TEE can be skipped before pulmonary vein isolation <PVI> by using MDCT. We enrolled 100 consecutive AF patients <paroxysmal AF in 73, persistent or long lasting AF in 27> who underwent PVI. LAA-T was defined as well-contoured echogenic mass in LAA using TEE. To assess LAA by MDCT, the Hounsfield unit <HU> density was measured at LAA proximal <LAAp> and distal <LAAd>. The cutoff value of LAAp/LAAd to provide 100% probability of LAA-T absence was calculated using receiver operating characteristic curves R<OC-C>. LAA-T was detected in 7 patients <7/27 patients with persistent or long lasting AF>. ROC-C indicates that LAAp/LAAd>0.43 demonstrates 100% specificity. Using this cutoff value, 76% patients can be diagnosed as absence of LAA-T solely by MDCT. In conclusion, LAA-T was observed only in persistent or long lasting AF patients. LAA-T can be excluded in 76% patients without using TEE. TEE could be unnecessary for PVI in PAF patients below the cutoff value of HU density.