Introduction
The COVID 19 pandemic has significantly affected health care delivery
across cardiac specialties, including cardiac electrophysiology (EP).
Infection prevention efforts mandate reallocation of resources with the
postponement of the elective procedures and minimization of invasive
pre-procedural
investigations1.
Catheter ablation of atrial fibrillation (AF) is a commonly performed
procedure in the EP lab and carries a risk of peri-procedural
thromboembolic cerebrovascular events
(CVEs)2. Left atrial
appendage (LAA) thrombus is the most common source of embolism in such
patients. To minimize the peri-procedural risk of CVEs, current
guidelines recommend at least 3 weeks of effective anticoagulation or
pre-procedural transesophageal echocardiographic (TEE) evaluation of LAA
for patients who present for their ablation procedure in
AF2. TEE is variably
employed in other populations of patients undergoing AF ablation based
on their stroke risk profile and physician preferences. Previous studies
have suggested the utility of pre-procedural cardiac computed tomography
(CT) in place of TEE for evaluation of LAA
thrombus3-9. In the
current study, we describe our institutional experience of transitioning
from pre-procedural TEE to cardiac CT for evaluation of LAA thrombus
during the COVID-19 pandemic (part of an effort to reduce COVID
transmission risks to healthcare providers), and the risk of
peri-procedural CVEs among patients undergoing pulmonary vein isolation
(PVI) with minimally interrupted peri-procedural anticoagulation before
and after this practice change.