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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.

Peer review status:UNDER REVIEW

26 May 2021Submitted to Journal of Cardiovascular Electrophysiology
01 Jun 2021Assigned to Editor
01 Jun 2021Submission Checks Completed
02 Jun 2021Reviewer(s) Assigned