AUTHOR=Yu Yi , Zhang Rui , Chen Yu-Han , Wang Ting , Tang Xiao-Li , Gong Chang-qi , Shao Yun , Wang Zheng , Wang Yue-Peng , Li Yi-Gang TITLE=Diagnostic value of real-time four-dimensional transesophageal echocardiography on the implant-related thrombus JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=Volume 10 - 2023 YEAR=2023 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1018877 DOI=10.3389/fcvm.2023.1018877 ISSN=2297-055X ABSTRACT=Objectives: To evaluate the diagnostic value of real-time four-dimensional transesophageal echocardiography (RT4D-TEE) for implant-related thrombus (IRT). Methods: We collected 1125 patients with atrial fibrillation from May 2019 to February 2022 in our hospital. All patients accepted transesophageal echocardiography (TEE) examination in order to exclude any thrombi before LAAC procedure. Results: There were 760 patients with LAAC, 66 patients with CIED and 299 patients without any implantations. A total of 40 patients with established diagnosis of IRT were further analyzed. The accurate detection rate of IRT by RT4D-TEE was 4.8% (40/826), which was higher than 3.8% (31/826) by 2D-TEE (P=0.004). No IRT was found on TEE in the rest 786 patients. These 40 patients were divided into LAAC (n=23) and CIED (n=17) group according to the results of RT4D-TEE. In the LAAC group, IRT distributed on different parts of the LAA occluder surface, 91.3% (21/23) with clumps of thrombi and 8.7% (2/23) with a thin layer of thrombi covering the surface of the occluder. In the CIED group, thrombi were seen attached to the leads in the right atrium and right ventricle. The thrombi were beaded in 17.6% (3/17), corded in 17.6% (3/17), and clotted in the remaining 64.7% (11/17) cases. After adjusting the anticoagulant dosage and followed up for 6 months, 20% (8/40) cases were successfully resolved, 67.5% (27/40) became smaller, and 12.5% (5/40) showed no changes. Conclusions: The accurate detection rate of IRT by RT4D-TEE was significantly higher than that by 2D-TEE. 2D-TEE has limitations, RT4D-TEE can be used as an effective complementary method. Imaging and some clinical features differ significantly between IRT on occluder and IRT on CIED lead.