Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making.

Item Type:	Refereed Article
Keywords:	computed tomographic angiography, cryptogenic stroke, left atrial appendage thrombus, transesophageal echocardiography
Research Division:	Medical and Health Sciences
Research Group:	Clinical Sciences
Research Field:	Rheumatology and Arthritis
Objective Division:	Health
Objective Group:	Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:	Skeletal System and Disorders (incl. Arthritis)
Author:	Pathan, F (Dr Faraz Pathan)
ID Code:	125954
Year Published:	2018
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2018-05-16
Last Modified:	2018-08-16
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