Author + information
- Received May 17, 2018
- Revision received August 20, 2018
- Accepted September 11, 2018
- Published online February 18, 2019.
- Antoine Milhem, MDa,∗ (, )
- Pierre Ingrand, MD, PhDb,
- Frédéric Tréguer, MDc,
- Olivier Cesari, MDd,
- Antoine Da Costa, MDe,
- Dominique Pavin, MDf,
- Philippe Rivat, MDg,
- Nicolas Badenco, MDh,
- Sélim Abbey, MDi,
- Noura Zannad, MDj,
- Pierre François Winum, MDk,
- Jacques Mansourati, MDl,
- Philippe Maury, MDm,
- Hugues Bader, MDn,
- Arnaud Savouré, MDo,
- Frédéric Sacher, MDp,
- Marius Andronache, MDq,
- Caroline Allix-Béguec, PhDa,
- Christian De Chillou, MD, PhDq,r,
- Frédéric Anselme, MD, PhDo,
- for the ATE Study Group
- aGroupe Hospitalier de la Rochelle Ré Aunis, La Rochelle, France
- bEpidemiology and Biostatistics, INSERM CIC 1402 Université de Poitiers, CHU Poitiers, Poitiers, France
- cClinique St-Joseph, Trélazé, France
- dClinique Saint Gatien, Tours, France
- eCHU Saint-Etienne, Saint-Etienne, France
- fCHU Rennes, Rennes, France
- gPolyclinique Vauban, Valenciennes, France
- hAPHP, Hôpital Pitié Salpêtrière, Paris, France
- iNouvelles Cliniques Nantaises, Groupe Confluent, Nantes, France
- jCHR Metz-Thionville, Metz, France
- kCHU Nîmes, Nîmes, France
- lCHU Brest, Brest, France
- mCHU Toulouse, Toulouse, France
- nCH Pau, Pau, France
- oCHU Rouen, Rouen, France
- pCHU Bordeaux, Bordeaux, France
- qCHU Nancy, Vandœuvre lès-Nancy, France
- rINSERM-IADI U1254, Vandœuvre lès-Nancy, France
- ↵∗Address for correspondence:
Dr. Antoine Milhem, Service de Cardiologie, Groupe Hospitalier de la Rochelle Ré Aunis, rue du Dr. Schweitzer, 17019 La Rochelle, France.
Objectives This study hypothesized that the association of D-dimer blood level and several clinical items in a new risk score could predict the absence of atrial thrombus.
Background Symptomatic and drug resistant atrial fibrillation (AF) can be treated by catheter ablation. The procedure-related risk of thromboembolism is limited by the pre-operative use of transesophageal echocardiography (TEE) to detect atrial thrombi.
Methods Patients admitted for catheter ablation of AF (n = 2,494) were prospectively included in a multicenter study. TEE was systematically performed before the procedure to search for atrial thrombus (primary endpoint). D-dimer level, CHADS2 score, left ventricular ejection fraction, pre-operative anticoagulation regimen, and medical history were collected. A logistic regression model was used to identify factors associated with the presence of atrial thrombus (hypertension, history of stroke, heart failure, D-dimer level >270 ng/ml). These factors were aggregated in a new score called atrial thrombus exclusion (ATE).
Results The incidence of atrial thrombus was 1.92%. CHADS2 score and D-dimer level were significantly associated with atrial thrombus (p < 0.0001 and p < 0.0001, respectively). A zero CHADS2 score failed to exclude all atrial thrombi (5 false negatives; sensitivity: 89.58%, specificity: 52.2%). No false negative was found with a zero ATE score, which had a specificity of 37% and a higher sensitivity (100%) than the CHADS2 score (p < 0.031) to predict the absence of intra-atrial thrombi on TEE. Conversely, the positive predictive value was poor, and the ATE score should not be used to conclude a positive diagnosis of thrombus.
Conclusions An ATE score of zero was strongly associated with the absence of atrial thrombus. This new score could be useful to rule out a diagnosis of atrial thrombus before catheter ablation of AF.
This study was supported by a grant from Medtronic. Dr. de Chillou has been a consultant for Biosense Webster, Abbott, Boston Scientific, and Stereotaxis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 17, 2018.
- Revision received August 20, 2018.
- Accepted September 11, 2018.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.