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Transition from Transesophageal Echocardiography to Cardiac Computed Tomography for the Evaluation of Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation and Incidence of Cerebrovascular Events During the COVID-19 Pandemic
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  • Tauseef Akhtar,
  • Ryan Wallace,
  • Usama Daimee,
  • Erica Hart,
  • Armin Arbab-Zadeh,
  • Joseph Marine,
  • Ronald Berger,
  • Hugh Calkins,
  • David Spragg
Tauseef Akhtar
Johns Hopkins School of Medicine
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Ryan Wallace
Johns Hopkins University School of Medicine
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Usama Daimee
Johns Hopkins University School of Medicine
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Erica Hart
Johns Hopkins University School of Medicine
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Armin Arbab-Zadeh
Johns Hopkins University School of Medicine
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Joseph Marine
Johns Hopkins Hospital
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Ronald Berger
Johns Hopkins Hospital
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Hugh Calkins
Johns Hopkins Hospital
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David Spragg
Johns Hopkins Hospital
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Abstract

Background Transesophageal echocardiography (TEE) is variably performed before atrial fibrillation (AF) ablation to evaluate left atrial appendage (LAA) thrombus. We describe our experience with transitioning to the pre-ablation cardiac computed tomography (CT) approach for the assessment of LAA thrombus during the COVID-19 pandemic. Methods We studied consecutive patients undergoing AF ablation at our center. The study cohort was divided into pre- vs. post-COVID groups. The pre-COVID cohort included ablations performed during 1 year before the COVID-19 pandemic; pre-ablation TEE was used routinely to evaluate LAA thrombus in high-risk patients. Post-COVID cohort included ablations performed during the 1 year after the COVID-19 pandemic; pre-ablation CT was performed in all patients, with TEE performed only in patients with LAA thrombus by CT imaging. The demographics, clinical history, imaging, and ablation characteristics, and peri-procedural cerebrovascular events (CVE) were recorded. Results A total of 637 patients (pre-COVID n=424, post-COVID n=213) were studied. The mean age was 65.6  10.1 years in the total cohort, and the majority were men. There was a significant increase in pre-ablation CT imaging from pre to post-COVID cohort (74.8 vs. 93.9%, p=<0.01), with a significant reduction in TEEs (34.6 vs. 3.7%, p=<0.01). One patient in the post-COVID cohort developed CVE following negative pre-ablation CT. However, the incidence of peri-procedural CVE between both cohorts remained statistically unchanged (0 vs. 0.4%, p=0.33). Conclusion Implementation of pre ablation CT-only imaging strategy with selective use of TEE for LAA thrombus evaluation is not associated with increased CVE risk during the COVID- 19 pandemic.
26 May 2021Submitted to Journal of Cardiovascular Electrophysiology
01 Jun 2021Submission Checks Completed
01 Jun 2021Assigned to Editor
02 Jun 2021Reviewer(s) Assigned
27 Jun 2021Review(s) Completed, Editorial Evaluation Pending
28 Jun 2021Editorial Decision: Revise Minor
06 Jul 20211st Revision Received
07 Jul 2021Assigned to Editor
07 Jul 2021Submission Checks Completed
07 Jul 2021Reviewer(s) Assigned
26 Jul 2021Review(s) Completed, Editorial Evaluation Pending
27 Jul 2021Editorial Decision: Revise Minor
29 Jul 20212nd Revision Received
02 Aug 2021Submission Checks Completed
02 Aug 2021Assigned to Editor
02 Aug 2021Reviewer(s) Assigned
21 Aug 2021Review(s) Completed, Editorial Evaluation Pending
24 Aug 2021Editorial Decision: Accept
Dec 2021Published in Journal of Cardiovascular Electrophysiology volume 32 issue 12 on pages 3125-3134. 10.1111/jce.15227