PT  - JOURNAL ARTICLE
AU  - Milhem, Antoine
AU  - Ingrand, Pierre
AU  - Tréguer, Frédéric
AU  - Cesari, Olivier
AU  - Da Costa, Antoine
AU  - Pavin, Dominique
AU  - Rivat, Philippe
AU  - Badenco, Nicolas
AU  - Abbey, Sélim
AU  - Zannad, Noura
AU  - Winum, Pierre François
AU  - Mansourati, Jacques
AU  - Maury, Philippe
AU  - Bader, Hugues
AU  - Savouré, Arnaud
AU  - Sacher, Frédéric
AU  - Andronache, Marius
AU  - Allix-Béguec, Caroline
AU  - De Chillou, Christian
AU  - Anselme, Frédéric
AU  - , 
AU  - Al Arnaout, Alain
AU  - Amara, Walid
AU  - Amelot, Mathieu
AU  - Bars, Clément
AU  - Becoulet, Lucile
AU  - Bru, Paul
AU  - Chevalier, Philippe
AU  - Darmon, Jean-Philippe
AU  - Deharo, Jean-Claude
AU  - Dompnier, Antoine
AU  - Duplantier-Duchene, Cécile
AU  - Extramiana, Fabrice
AU  - Faugier, Jean-Paul
AU  - Guenancia, Charles
AU  - Horvilleur, Jérôme
AU  - Jourda, François
AU  - Laurent, Gabriel
AU  - Lellouche, Nicolas
AU  - Magnin Poull, Isabelle
AU  - Piot, Olivier
AU  - Roux, Antoine
AU  - Saludas, Yannick
AU  - Seitz, Julien
AU  - Taieb, Jérôme
TI  - Exclusion of Intra-Atrial Thrombus Diagnosis Using D-Dimer Assay Before Catheter Ablation of Atrial Fibrillation
AID  - 10.1016/j.jacep.2018.09.009
DP  - 2018 Oct 31
TA  - JACC: Clinical Electrophysiology
PG  - 783
4099  - http://electrophysiology.onlinejacc.org/content/early/2018/10/23/j.jacep.2018.09.009.short
4100  - http://electrophysiology.onlinejacc.org/content/early/2018/10/23/j.jacep.2018.09.009.full
AB  - 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.