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Gupta S, Lutnik M, Cacioppo F, Lindmayr T, Schuetz N, Tumnitz E, Friedl L, Boegl M, Schnaubelt S, Domanovits H, Spiel A, Toth D, Varga R, Raudner M, Herkner H, Schwameis M, Niederdoeckl J. Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation-An 11-Year Experience from an Academic Emergency Department. Diagnostics (Basel) 2024; 14:699. [PMID: 38611612 PMCID: PMC11011443 DOI: 10.3390/diagnostics14070699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
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.
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Affiliation(s)
- Sophie Gupta
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Martin Lutnik
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Filippo Cacioppo
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Teresa Lindmayr
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Nikola Schuetz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Elvis Tumnitz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Lena Friedl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Magdalena Boegl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
- Clinical Division of Gynaecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Alexander Spiel
- Department of Emergency Medicine, Clinic Ottakring, Vienna Healthcare Group, 1160 Vienna, Austria;
| | - Daniel Toth
- Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria; (D.T.); (R.V.); (M.R.)
| | - Raoul Varga
- Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria; (D.T.); (R.V.); (M.R.)
| | - Marcus Raudner
- Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria; (D.T.); (R.V.); (M.R.)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
| | - Jan Niederdoeckl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (F.C.); (T.L.); (N.S.); (E.T.); (L.F.); (M.B.); (S.S.); (H.D.); (H.H.); (J.N.)
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria;
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