医学
血栓
心房颤动
心脏病学
内科学
导管消融
烧蚀
房性心动过速
冲程(发动机)
人口
预测值
试验预测值
金标准(测试)
机械工程
环境卫生
工程类
作者
Antoine Milhem,Frédéric Anselme,Antoine Da Costa,Sélim Abbey,Jacques Mansourati,Hugues Bader,Pierre Winum,Nicolas Badenco,Philippe Maury,Antoine Dompnier,Dipen Shah,Nicolas Joner,J. Taïeb,Julien Bertrand,F. Tréguer,Mathieu Amelot,Pierre Ingrand,Caroline Allix‐Béguec
标识
DOI:10.1016/j.jacep.2023.08.019
摘要
In a preliminary study in patients hospitalized for catheter ablation of atrial fibrillation (AF), the atrial thrombus exclusion (ATE) score (stroke, hypertension, heart failure, and D-dimers >270 ng/mL) was developed to rule out the diagnosis of intra-atrial thrombus, with a negative predictive value (NPV) of 100%, and to avoid performing transesophageal echocardiography (TEE).The present study was designed to prospectively confirm the NPV of the ATE score in an independent population.Consecutive patients hospitalized for catheter ablation of AF or left atrial tachycardia (LAT) were prospectively enrolled in a multicenter study. D-dimer levels were measured within 48 hours before ablation. An ATE score of 0 was considered predictive of no thrombus. TEE was routinely performed at the beginning or just before the ablation procedure. The primary endpoint was the presence of atrial thrombus diagnosed by TEE.The analysis included 3,072 patients (53.3% paroxysmal AF, 36.7% persistent AF, and 10% LAT). A thrombus was detected in 29 patients (0.94%; 95% CI: 0.63%-1.35%), all on appropriate anticoagulant therapy. An ATE score of 0 was observed in 818 patients (26.6%), and the sensitivity, specificity, positive predictive value, and NPV were 93.1%, 26.8%, 1.2%, and 99.8%, respectively. Follow-up of the 2 false negative patients revealed the persistence of chronic organized thrombi.In patients hospitalized for catheter ablation of AF or LAT, the ATE score identifies a population at very low risk for atrial thrombus. In consultation with the patient, the cardiologist may consider not performing a preoperative TEE in case of an ATE score of 0.
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