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The use of cardiac‐CT alone to exclude left atrial thrombus before atrial fibrillation ablation: Efficiency, safety, and cost analysis
Author(s) -
Mosleh Wassim,
Sheikh Ali,
Said Zaid,
Ahmed Mohamed AbdelAal,
Gadde Siri,
Shah Tanvi,
Wilson Michael F.,
Beck Hiroko,
Kim Chee,
Sharma Umesh C.
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13353
Subject(s) - medicine , atrial fibrillation , cryoablation , cohort , retrospective cohort study , thrombus , cardiology , ablation , stroke (engine) , pulmonary vein , prospective cohort study , radiology , mechanical engineering , engineering
Background Atrial 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. Methods We 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. Results Seventy 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. Conclusions In 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.