Pre-ablation imaging protocol for LAA thrombus evaluation
In the pre-COVID cohort, pre-procedural TEE was performed routinely for
all the patients presenting in AF or atrial flutter (AFL) on the day of
ablation, and ablation was conducted after LAA thrombus was ruled out.
CT scans in the pre-COVID cohort were not analyzed for the presence or
absence of LAA thrombus but were used solely for assistance in
electroanatomical mapping during the ablation itself. In the post-COVID
cohort, we implemented a cardiac CT-based protocol for LAA thrombus
evaluation, with TEE used selectively only in patients with findings
suggestive of LAA thrombus on CT imaging. All patients underwent CT
imaging with first- and second-pass image acquisition to assess for LAA
thrombus. TEE imaging was triggered only in patients with positive CT
scan findings. If CT imaging was negative, or if triggered TEE imaging
was negative, patients underwent ablation as planned. If triggered TEE
was positive for LAA thrombus, the ablation procedure was canceled.