A limitation of CMR is its lower spatial resolution and longer acquisition times when compared with CT. MRI Heart Function and Morphology Without IV Contrast MRI heart without IV contrast can assess the size of left atrium. There is scant data in the literature supporting the use of noncontrast CMR for detecting LAA thrombi. Kitkungvan et al [28] compared CMR with TEE for detecting LAA thrombi. Steady-state free-precession (SSFP) cine MRI had a 91.6% diagnostic accuracy, 66.7% sensitivity, and 92.5% specificity. There is no relevant literature to support the use of nonenhanced CMR in quantifying LAA size and morphology to guide preprocedural planning for LAA occlusion procedures. SPECT or SPECT/CT MPI Rest and Stress There is no relevant literature to support the use of SPECT or SPECT/CT MPI rest and stress to guide preprocedural planning for LAA endovascular occlusion procedures. US Echocardiography Transthoracic Resting Transthoracic echocardiography TTE assesses LA parameters that can help with patient risk stratification for thromboembolic events such as LA volume/volume index, left ventricular ejection fraction [41], and LA size [42]. However, there is no relevant literature to support the use of TTE specifically for preprocedural planning to guide LAA endovascular occlusion. Variant 3: Adult. Atrial fibrillation. Preprocedural planning prior to electrical or pharmacologic cardioversion. Arteriography Coronary There is no relevant literature to support the use of coronary arteriography to guide preprocedural planning for cardioversion. Catheter Venography Pulmonary There is no relevant literature to support the use of catheter pulmonary venography to guide preprocedural planning for cardioversion. Left Atrial Procedures in Atrial Fibrillation CT Chest With IV Contrast CT chest can, in some cases, demonstrate thrombi; however, it is not optimized for LA assessment.
Preprocedural Planning for Left Atrial Procedures in Atrial Fibrillation. A limitation of CMR is its lower spatial resolution and longer acquisition times when compared with CT. MRI Heart Function and Morphology Without IV Contrast MRI heart without IV contrast can assess the size of left atrium. There is scant data in the literature supporting the use of noncontrast CMR for detecting LAA thrombi. Kitkungvan et al [28] compared CMR with TEE for detecting LAA thrombi. Steady-state free-precession (SSFP) cine MRI had a 91.6% diagnostic accuracy, 66.7% sensitivity, and 92.5% specificity. There is no relevant literature to support the use of nonenhanced CMR in quantifying LAA size and morphology to guide preprocedural planning for LAA occlusion procedures. SPECT or SPECT/CT MPI Rest and Stress There is no relevant literature to support the use of SPECT or SPECT/CT MPI rest and stress to guide preprocedural planning for LAA endovascular occlusion procedures. US Echocardiography Transthoracic Resting Transthoracic echocardiography TTE assesses LA parameters that can help with patient risk stratification for thromboembolic events such as LA volume/volume index, left ventricular ejection fraction [41], and LA size [42]. However, there is no relevant literature to support the use of TTE specifically for preprocedural planning to guide LAA endovascular occlusion. Variant 3: Adult. Atrial fibrillation. Preprocedural planning prior to electrical or pharmacologic cardioversion. Arteriography Coronary There is no relevant literature to support the use of coronary arteriography to guide preprocedural planning for cardioversion. Catheter Venography Pulmonary There is no relevant literature to support the use of catheter pulmonary venography to guide preprocedural planning for cardioversion. Left Atrial Procedures in Atrial Fibrillation CT Chest With IV Contrast CT chest can, in some cases, demonstrate thrombi; however, it is not optimized for LA assessment.