Author + information
- Received November 26, 2017
- Accepted December 21, 2017
- Published online April 2, 2018.
- Faraz Pathan, MBBSa,
- Harvey Hecht, MDb,∗ (, )
- Jagat Narula, MD, PhDb and
- Thomas H. Marwick, MBBS, PhD, MPHc
- aMenzies Institute for Medical Research, Hobart, Australia
- bIcahn School of Medicine at Mount Sinai, New York, New York
- cBaker Heart and Diabetes Institute, Melbourne, Australia
- ↵∗Address for correspondence:
Dr. Harvey S. Hecht, Mount Sinai Saint Luke’s Hospital, 1111 Amsterdam Avenue, New York, New York 10025.
Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making.
- computed tomographic angiography
- cryptogenic stroke
- left atrial appendage thrombus
- transesophageal echocardiography
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Pathan and Hecht contributed equally to this paper and are joint first authors.
- Received November 26, 2017.
- Accepted December 21, 2017.
- 2018 American College of Cardiology Foundation
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