Prevalence and Clinical Characteristics Associated With Left Atrial Appendage Thrombus in Fully Anticoagulated Patients Undergoing Catheter‐Directed Atrial Fibrillation Ablation

Wallace, Thomas W.; Atwater, Brett D.; Daubert, James P.; Voora, Deepak; Crowley, Anna Lisa; Bahnson, Tristram D.; Hranitzky, Patrick

doi:10.1111/j.1540-8167.2010.01729.x

Cited by 58 publications

(52 citation statements)

References 19 publications

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“…However, many laboratories conduct a TEE in all patients before ablation since thrombus can be observed even in low-risk patients with paroxysmal AF. 155 …”

Section: Periprocedural Management Of Patients Who Take Noacsmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

212

147

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Non–vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.

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“…However, many laboratories conduct a TEE in all patients before ablation since thrombus can be observed even in low-risk patients with paroxysmal AF. 155 …”

Section: Periprocedural Management Of Patients Who Take Noacsmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

212

147

View full text Add to dashboard Cite

show abstract

“…Prior studies of TEE have identified thrombus in up to 3%–5% of patients referred for ablation. 1213 Alternatively, it is also possible that the CHADS 2 score (or equivalent historical markers) is a better discriminator for patients at high risk of stroke following ablation and TEE does not add significantly to risk stratification. Nevertheless, the use of TEE to reduce the risk of periprocedural stroke/TIA has not been formally evaluated in a prospective study despite recommendations by expert consensus.…”

Section: Discussionmentioning

confidence: 99%

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation

Steinberg

Hammill

Daubert

et al. 2014

Heart

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Objective Catheter ablation of atrial fibrillation (AF) has become an increasingly safe and effective therapy. This has been partly attributed to the use of adjunctive imaging modalities. We aimed to describe the use and associated outcomes of periprocedural imaging for AF ablation. Methods We studied all Medicare fee-for-service claims for AF ablation from July 2007 to December 2009, and identified associated imaging studies before and during ablation, including transoesophageal echocardiography (TEE), intracardiac echocardiography (ICE), CT and MRI. The primary outcomes were death, stroke or transient ischaemic attack (TIA), repeat ablation, and bleeding (pericardial or vascular) at 6 months. Results 11 525 patients underwent AF ablation during the study period. There was significant variation in imaging use at the practice level. In addition to electroanatomic mapping, 53% (n=6060/11 525) underwent TEE, 67% (n=7715/11 525) received ICE, and 50% (n=5724/11 525) underwent a preprocedure CT or MRI. Imaging generally increased from 2007 to 2009. After adjustment, the use of preablation CT or MRI was associated with a significantly lower risk of stroke or TIA (0.4% vs 0.9%, adjusted HR 0.46, 95% CI 0.28 to 0.74, p=0.002), and the use of ICE was associated with a lower risk of repeat ablation (5.7% vs 8.5%, adjusted HR 0.59, 95% CI 0.37 to 0.92, p=0.02) but higher risk of bleeding (1.1% vs 0.7%, adjusted HR 1.76, 95% CI 1.15 to 2.70, p=0.009). Conclusions Periprocedural imaging for AF ablation is increasingly used, although practice patterns vary widely. Our data suggest that periprocedural imaging is associated with better outcomes after catheter ablation; however, prospective studies of periprocedural imaging strategies are warranted.

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“…cardiomyopathy and LA dilatation. However, there are other studies which contradict this data 29 and therefore at the moment it would seem reasonable to continue a cautious approach with TOE as a standard part of the work up. 30 …”

Section: Pre-proceduresmentioning

confidence: 82%

The role of echocardiography in the management of atrial fibrillation

Wheeler

Masani

2011

European Journal of Echocardiography

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Prevalence and Clinical Characteristics Associated With Left Atrial Appendage Thrombus in Fully Anticoagulated Patients Undergoing Catheter‐Directed Atrial Fibrillation Ablation

Abstract: Despite full anticoagulation, 3.6% of patients undergoing AF ablation had LAA thrombus. We recommend that all patients, regardless of LV function or left atrial size, should undergo preprocedural TEE to exclude the presence of LAA thrombus.

Cited by 58 publications

References 19 publications

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation

The role of echocardiography in the management of atrial fibrillation

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