BACKGROUND: We sought to develop and validate an intracardiac echocardiography (ICE) imaging strategy for evaluation of left atrial (LA) appendage (LAA) anatomy and function to clarify equivocal findings of LAA thrombus with transesophageal echocardiography (TEE). METHODS: A total of 56 patients with ICE imaging of the LAA for thrombus evaluation before atrial fibrillation (AF) or ventricular tachycardia (VT) ablation were included for analysis. Serial views of the LAA were obtained for evaluating anatomic structures and flow as the ICE transducer was advanced from the right ventricular outflow tract to the pulmonary artery. ICE imaging of the LAA was selectively performed in 9 of 56 patients following equivocal findings of thrombus on TEE in order to evaluate the complementary role of ICE to TEE in the diagnosis of LAA thrombus. RESULTS: ICE imaging of the LAA in 56 patients with AF (n = 42) or VT (n = 14) measured the long-(5.0 ± 1.0 cm) and short-axis dimension (1.8 ± 0.5 cm), and peak emptying flow velocity (50 ± 23 cm/s). Of 56 patients, 47 had ICE imaging of LAA with no thrombus. In the remaining 9 patients, 6 had "equivocal" LAA thrombus on TEE, with 3 of these 6 showing marked spontaneous echo contrast (SEC), whereas ICE detected one patient with LAA thrombus and the other 5 without thrombus (two with severe SEC/sluggish flow); the remaining 3 had "high suspicion" for thrombus detected by TEE, whereas ICE detected only one with LAA thrombus. Based on ICE diagnosis, two patients with LAA thrombus had the procedure cancelled, and all others had successful completion of the scheduled procedures. CONCLUSION: ICE can provide serial assessment, multiple views, and detailed imaging of the LAA to reliably diagnose the presence of thrombus. Our findings support the use of ICE when equivocal TEE findings require confirmation prior to electrophysiological procedures.
BACKGROUND: We sought to develop and validate an intracardiac echocardiography (ICE) imaging strategy for evaluation of left atrial (LA) appendage (LAA) anatomy and function to clarify equivocal findings of LAA thrombus with transesophageal echocardiography (TEE). METHODS: A total of 56 patients with ICE imaging of the LAA for thrombus evaluation before atrial fibrillation (AF) or ventricular tachycardia (VT) ablation were included for analysis. Serial views of the LAA were obtained for evaluating anatomic structures and flow as the ICE transducer was advanced from the right ventricular outflow tract to the pulmonary artery. ICE imaging of the LAA was selectively performed in 9 of 56 patients following equivocal findings of thrombus on TEE in order to evaluate the complementary role of ICE to TEE in the diagnosis of LAA thrombus. RESULTS:ICE imaging of the LAA in 56 patients with AF (n = 42) or VT (n = 14) measured the long-(5.0 ± 1.0 cm) and short-axis dimension (1.8 ± 0.5 cm), and peak emptying flow velocity (50 ± 23 cm/s). Of 56 patients, 47 had ICE imaging of LAA with no thrombus. In the remaining 9 patients, 6 had "equivocal" LAA thrombus on TEE, with 3 of these 6 showing marked spontaneous echo contrast (SEC), whereas ICE detected one patient with LAA thrombus and the other 5 without thrombus (two with severe SEC/sluggish flow); the remaining 3 had "high suspicion" for thrombus detected by TEE, whereas ICE detected only one with LAA thrombus. Based on ICE diagnosis, two patients with LAA thrombus had the procedure cancelled, and all others had successful completion of the scheduled procedures. CONCLUSION:ICE can provide serial assessment, multiple views, and detailed imaging of the LAA to reliably diagnose the presence of thrombus. Our findings support the use of ICE when equivocal TEE findings require confirmation prior to electrophysiological procedures.
Authors: Chenni S Sriram; Javier E Banchs; Talal Moukabary; Raman Moradkhan; Mario D Gonzalez Journal: J Interv Card Electrophysiol Date: 2015-05-03 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: J Interv Card Electrophysiol Date: 2017-10 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: J Arrhythm Date: 2017-09-15