Exclusion of Intra-Atrial Thrombus Diagnosis Using D-Dimer Assay Before Catheter Ablation of Atrial Fibrillation
Antoine Milhem
(1)
,
Pierre Ingrand
(2)
,
Frédéric Tréguer
(3)
,
Olivier Cesari
(4)
,
Antoine da Costa
(5)
,
Dominique Pavin
(6)
,
Philippe Rivat
(7)
,
Nicolas Badenco
(8)
,
Sélim Abbey
(9)
,
Noura Zannad
(10)
,
Pierre François Winum
(11)
,
Jacques Mansourati
,
Philippe Maury
(12)
,
Hugues Bader
(13)
,
Arnaud Savouré
(14)
,
Frédéric Sacher
(15)
,
Marius Andronache
(16)
,
Caroline Allix-Béguec
(1)
,
Christian de Chillou
(17, 16)
,
Frédéric Anselme
(14)
,
Alain Al Arnaout
,
Walid Amara
,
Mathieu Amelot
,
Clément Bars
,
Lucile Becoulet
,
Paul Bru
,
Philippe Chevalier
,
Jean-Philippe Darmon
,
Jean-Claude Deharo
,
Antoine Dompnier
,
Cécile Duplantier-Duchene
,
Fabrice Extramiana
,
Jean-Paul Faugier
,
Charles Guenancia
,
Jérôme Horvilleur
,
François Jourda
,
Gabriel Laurent
,
Nicolas Lellouche
,
Isabelle Magnin Poull
,
Olivier Piot
,
Antoine Roux
,
Yannick Saludas
,
Julien Seitz
,
Jérôme Taieb
1
Centre Hospitalier de La Rochelle (CHR)
2 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
3 Clinique St-Joseph [Trélazé] - Clinique Saint-Joseph de Trélazé [France]
4 Clinique Saint Gatien
5 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
7 Polyclinique Vauban
8 CHU Pitié-Salpêtrière [AP-HP]
9 Nouvelles Cliniques Nantaises
10 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
11 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
12 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
13 Centre hospitalier de Pau
14 CHU Rouen
15 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
16 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
17 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
2 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
3 Clinique St-Joseph [Trélazé] - Clinique Saint-Joseph de Trélazé [France]
4 Clinique Saint Gatien
5 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
7 Polyclinique Vauban
8 CHU Pitié-Salpêtrière [AP-HP]
9 Nouvelles Cliniques Nantaises
10 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
11 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
12 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
13 Centre hospitalier de Pau
14 CHU Rouen
15 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
16 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
17 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
Pierre Ingrand
- Function : Author
- PersonId : 1372915
- ORCID : 0000-0002-7765-2520
- IdRef : 031207774
Antoine da Costa
- Function : Author
- PersonId : 1077979
- ORCID : 0000-0003-3302-9988
- IdRef : 097486736
Jacques Mansourati
- Function : Author
- PersonId : 765861
- ORCID : 0000-0002-6697-7194
Philippe Maury
- Function : Author
- PersonId : 764669
- ORCID : 0000-0002-4800-1841
- IdRef : 174165412
Caroline Allix-Béguec
- Function : Author
- PersonId : 1171940
- IdHAL : caroline-allix-beguec
- ORCID : 0000-0001-7642-4844
Christian de Chillou
- Function : Author
- PersonId : 1097029
Alain Al Arnaout
- Function : Contributor
Walid Amara
- Function : Contributor
Mathieu Amelot
- Function : Contributor
Clément Bars
- Function : Contributor
Lucile Becoulet
- Function : Contributor
Paul Bru
- Function : Contributor
Philippe Chevalier
- Function : Contributor
Jean-Philippe Darmon
- Function : Contributor
Jean-Claude Deharo
- Function : Contributor
- PersonId : 764161
- ORCID : 0000-0002-1534-3845
Antoine Dompnier
- Function : Contributor
Cécile Duplantier-Duchene
- Function : Contributor
Fabrice Extramiana
- Function : Contributor
- PersonId : 761068
- ORCID : 0000-0001-8123-4842
- IdRef : 08929100X
Jean-Paul Faugier
- Function : Contributor
Charles Guenancia
- Function : Contributor
- PersonId : 780616
- ORCID : 0000-0002-3554-7714
- IdRef : 172394619
Jérôme Horvilleur
- Function : Contributor
François Jourda
- Function : Contributor
Gabriel Laurent
- Function : Contributor
Nicolas Lellouche
- Function : Contributor
- PersonId : 895220
- ORCID : 0000-0001-8462-2218
- IdRef : 075154625
Isabelle Magnin Poull
- Function : Contributor
Olivier Piot
- Function : Contributor
- PersonId : 773543
- ORCID : 0000-0002-6311-4983
Antoine Roux
- Function : Contributor
Yannick Saludas
- Function : Contributor
Julien Seitz
- Function : Contributor
Jérôme Taieb
- Function : Contributor
Abstract
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.