{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T18:04:13Z","timestamp":1764353053969,"version":"3.46.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":51,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The presence of a left atrial appendage (LAA) thrombus is an absolute contraindication for ablation. Despite the use of oral anticoagulant (OAC) therapy, LAA thrombi may still occur. The objective of this study is to identify the incidence of LAA thrombi in transoesophageal echocardiography (TEE) (the gold standard) and computed tomography (CT) scans and to investigate any correlation in thrombus detection between the two methods. Additionally, the study aims to investigate whether LAA flow velocity or volume influences thrombus detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Between May 2018 and October 2023, patients with atrial fibrillation\/atrial tachycardia (AF\/AT) under OAC, which were scheduled for AF catheter ablation, were included. TEE and CT were carried out at intervals of up to 7 days. LAA flow velocity was measured in the TEE. The volume of the LA, including LAA, excluding the pulmonary veins (PV), was obtained from a 3D reconstruction of the LA from CT. The study included 283 patients (pts), mean age of 66y (\u00b1 9 years), 182 male, mean CHA\u2082DS\u2082-VA score 3 [0\u20137]. All pts were orally anticoagulated with the majority under non-vitamin K antagonist oral anticoagulant (NOAC) (n = 265). Mean LA volume (LA + LAA) was 158\u2005mL (\u00b1 45\u2005mL). LAA flow velocity was reduced (&amp;lt;40\u2005cm\/s) in 119 pts (42%). In the majority of cases TEE and CT were performed at the same day (51%) or with an interval of 1 day (22%). A LAA thrombus was identified in 35 (12%) patients at least in one of the two methods. CT detected a thrombus in 27 patients, while TEE identified a thrombus in 16 patients, with both methods agreeing in 8 cases. A significant association between LAA flow velocity and thrombus detection by TEE was observed (P &amp;lt; 0.001; r = 0.36). In contrast, no significant relationship was observed between left atrial volume and thrombus presence on CT (P = 0.964).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In 12% of OAC-treated patients, a thrombus was detected in at least one exam, with concordant TEE and CT diagnoses in only 25%. Both methods excluded thrombi in 80% of cases. LAA flow velocity correlated with TEE findings, whereas LA volume showed no association with CT. Discrepancies highlight diagnostic challenges: TEE is operator-dependent, and CT is limited by flow and timing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyaf122","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T12:51:29Z","timestamp":1763211089000},"source":"Crossref","is-referenced-by-count":0,"title":["Left atrial appendage thrombus detection in routine workflow for patients with atrial fibrillation under oral anticoagulation: transoesophageal echocardiography vs. cardiac computed tomography"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1192-6963","authenticated-orcid":false,"given":"Henrike","family":"Stolterfoht","sequence":"first","affiliation":[{"name":"Division of Cardiology, Angiology and Intensive Care, University Hospital Jena ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6288-6087","authenticated-orcid":false,"given":"Stephanie","family":"Gr\u00e4ger","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Intensive Care, University Hospital Jena ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Hamadanchi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Intensive Care, University Hospital Jena ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"Surber","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Intensive Care, University Hospital Jena ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P Christian","family":"Schulze","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Intensive Care, University Hospital Jena ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anett","family":"Gro\u00dfe","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Intensive Care, University Hospital Jena ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"2025112813023811200_qyaf122-B1","doi-asserted-by":"crossref","first-page":"e347","DOI":"10.1161\/CIR.0000000000001209","article-title":"2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association","volume":"149","author":"Martin","year":"2024","journal-title":"Circulation"},{"key":"2025112813023811200_qyaf122-B2","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1002\/clc.22931","article-title":"A review of factors associated with maintenance of sinus rhythm after elective electrical cardioversion for atrial fibrillation","volume":"41","author":"Ecker","year":"2018","journal-title":"Clin Cardiol"},{"key":"2025112813023811200_qyaf122-B3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ijcard.2015.07.020","article-title":"Restoration of sinus rhythm results in early and late improvements in the functional reserve of the heart following direct current cardioversion of persistent AF: FRESH-AF","volume":"199","author":"Gilbert","year":"2015","journal-title":"Int J Cardiol"},{"key":"2025112813023811200_qyaf122-B4","doi-asserted-by":"crossref","first-page":"816","DOI":"10.3892\/etm.2015.2545","article-title":"Effect of catheter ablation versus antiarrhythmic drugs on atrial fibrillation: a meta-analysis of randomized controlled trials","volume":"10","author":"Shi","year":"2015","journal-title":"Exp Ther Med"},{"key":"2025112813023811200_qyaf122-B5","doi-asserted-by":"crossref","first-page":"e0163755","DOI":"10.1371\/journal.pone.0163755","article-title":"Radiofrequency catheter ablation improves the quality of life measured with a short form-36 questionnaire in atrial fibrillation patients: a systematic review and meta-analysis","volume":"11","author":"Kim","year":"2016","journal-title":"PLoS One"},{"key":"2025112813023811200_qyaf122-B6","first-page":"252","article-title":"Assessment and management of the left atrial appendage thrombus in patients with nonvalvular atrial fibrillation","volume":"34","author":"Zhan","year":"2018","journal-title":"Can J Cardiol"},{"key":"2025112813023811200_qyaf122-B7","first-page":"1277","article-title":"Ineffective anticoagulation prior to elective electric cardioversion for atrial fibrillation. 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