Transition from transesophageal echocardiography to cardiac computed tomography for the evaluation of left atrial appendage thrombus prior to atrial fibrillation ablation and incidence of cerebrovascular events during the COVID‐19 pandemic.

Background: Transesophageal echocardiography (TEE) is variably performed before atrial fibrillation (AF) ablation to evaluate left atrial appendage (LAA) thrombus. We describe our experience with transitioning to the pre‐ablation cardiac computed tomography (CT) approach for the assessment of LAA thrombus during the COVID‐19 pandemic. Methods: We studied consecutive patients undergoing AF ablation at our center. The study cohort was divided into pre‐ versus post‐COVID groups. The pre‐COVID cohort included ablations performed during the 1 year before the COVID‐19 pandemic; pre‐ablation TEE was used routinely to evaluate LAA thrombus in high‐risk patients. Post‐COVID cohort included ablations performed during the 1 year after the COVID‐19 pandemic; pre‐ablation CT was performed in all patients, with TEE performed only in patients with LAA thrombus by CT imaging. The demographics, clinical history, imaging, and ablation characteristics, and peri‐procedural cerebrovascular events (CVEs) were recorded. Results: A total of 637 patients (pre‐COVID n = 424, post‐COVID n = 213) were studied. The mean age was 65.6 ± 10.1 years in the total cohort, and the majority were men. There was a significant increase in pre‐ablation CT imaging from pre‐ to post‐COVID cohort (74.8% vs. 93.9%, p ≤.01), with a significant reduction in TEEs (34.6% vs. 3.7%, p ≤.01). One patient in the post‐COVID cohort developed CVE following negative pre‐ablation CT. However, the incidence of peri‐procedural CVE between both cohorts remained statistically unchanged (0% vs. 0.4%, p =.33). Conclusion: Implementation of pre‐ablation CT‐only imaging strategy with selective use of TEE for LAA thrombus evaluation is not associated with increased CVE risk during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]