Perspective:

While TEE is commonly performed to evaluate for LAA thrombus in patients planned for atrial ablation procedures, it is an invasive test and typically requires sedation. CMR or computed tomography (CT) are typically used for pulmonary vein mapping, and several studies have reported that CT has excellent accuracy to identify LAA thrombus, particularly when a delayed scan is added to the protocol. A single test that combines both pulmonary vein mapping and LAA assessment would be appealing, as it could lower costs and reduce the number of imaging procedures required. This study reports that CMR can identify LAA thrombus, although this retrospective study includes only a small number of patients with LAA thrombus, and the sensitivity of contrast-enhanced CMR and cine-CMR is limited. Before this can be considered for clinical use, further study is needed that includes a prospective and multicenter design, and examines a larger cohort with a greater number of LAA thrombi.