The use of cardiac-CT alone to exclude left atrial thrombus before atrial fibrillation ablation: Efficiency, safety, and cost analysis.

التفاصيل البيبلوغرافية
العنوان:	The use of cardiac-CT alone to exclude left atrial thrombus before atrial fibrillation ablation: Efficiency, safety, and cost analysis.
المؤلفون:	Mosleh W; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Sheikh A; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Said Z; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Ahmed MA; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Gadde S; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Shah T; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Wilson MF; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Beck H; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Kim C; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA., Sharma UC; Division of Cardiology, Department of Medicine, University at Buffalo, Buffalo, NY, USA.
المصدر:	Pacing and clinical electrophysiology : PACE [Pacing Clin Electrophysiol] 2018 Jul; Vol. 41 (7), pp. 727-733. Date of Electronic Publication: 2018 Jun 04.
نوع المنشور:	Journal Article; Research Support, N.I.H., Extramural
اللغة:	English
بيانات الدورية:	Publisher: Futura Pub. Co. Country of Publication: United States NLM ID: 7803944 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-8159 (Electronic) Linking ISSN: 01478389 NLM ISO Abbreviation: Pacing Clin Electrophysiol Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Mount Kisco, N. Y. : Futura Pub. Co., c1978-
مواضيع طبية MeSH:	Catheter Ablation* , Costs and Cost Analysis, Atrial Fibrillation/surgery , Cardiac Imaging Techniques/economics , Cardiac Imaging Techniques/methods , Heart Diseases/diagnostic imaging , Preoperative Care/methods , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed/economics, Atrial Fibrillation/complications ; Cardiac Imaging Techniques/adverse effects ; Female ; Heart Atria/diagnostic imaging ; Heart Diseases/complications ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thrombosis/complications ; Tomography, X-Ray Computed/adverse effects
مستخلص:	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. (© 2018 Wiley Periodicals, Inc.)
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معلومات مُعتمدة:	K08 HL131987 United States HL NHLBI NIH HHS; KL2 TR001413 United States TR NCATS NIH HHS; UL1 TR001412 United States TR NCATS NIH HHS
فهرسة مساهمة:	Keywords: CCTA; atrial fibrillation; left atrial thrombus; transesophageal echocardiography
تواريخ الأحداث:	Date Created: 20180419 Date Completed: 20191212 Latest Revision: 20240719
رمز التحديث:	20240719
مُعرف محوري في PubMed:	PMC6192873
DOI:	10.1111/pace.13353
PMID:	29667208
قاعدة البيانات:	MEDLINE

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تدمد:	1540-8159
DOI:	10.1111/pace.13353