Prevalence and Management of Atrial Thrombi in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation

Göldi, Tobias; Krisai, Philipp; Knecht, Sven; Aeschbacher, Stefanie; Spies, Florian; Zeljković, Ivan; Kaufmann, Beat A.; Schaer, Beat; Conen, David; Reichlin, Tobias; Oßwald, Stefan; Sticherling, Christian; Kühne, Michael

doi:10.1016/j.jacep.2019.09.003

Cited by 13 publications

(19 citation statements)

References 27 publications

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“…Furthermore, advances in ultrasound devices may enable echocardiographers to better visualize the LAA and by decreasing uncertainty allow more patients to be cardioverted. Our reported incidence also more closely resembles the very low incidence of LAA thrombi in patients before a pulmonary vein isolation procedure as reported recently in a study by Göldi et al 9 . It should be noted, however, that these patients were younger (61 vs. 69 years) and comparatively healthier (e.g., CHA 2 DS 2 -VASc score of 1.8 vs. 2.7) than our included patient population.…”

Section: Discussionsupporting

confidence: 91%

Incidence and predictors of left atrial appendage thrombus on transesophageal echocardiography before elective cardioversion

Wegner

Radke

Ellermann

et al. 2022

Sci Rep

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Guidelines recommend transesophageal echocardiography (TEE) before cardioversion in thrombogenic arrhythmias when the requirement of ≥ 3 weeks of anticoagulation is not met. Current data to support this approach, especially with direct oral anticoagulants (DOAC), are scarce. We analyzed consecutive elective pre-cardioversion TEE in a high-volume electrophysiology center for the occurrence of left atrial appendage (LAA) thrombi or reduced LAA flow velocity. Possible predictors were recorded and compared in a multivariate logistic regression analysis. Consecutive pre-cardioversion TEE in 512 patients (148 female, median age 69 years) were included. In all patients, indication for TEE was either intake of anticoagulation < 3 weeks before cardioversion or uncertain adherence to the prescribed anticoagulation regimen. Of the 512 TEE, 19 (3.7%) depicted a LAA thrombus. An additional 41 patients (8.0%) showed either a reduced LAA flow velocity (≤ 20 cm/s), LAA sludge, or both. In a multivariate logistic regression analysis, QRS width on admission 12-lead ECG emerged as a possible predictor of LAA thrombus and reduced LAA flow (p = 0.008). Noteworthy, a high CHA2DS2-VASc score was not associated with an increased risk of reduced LAA emptying velocity and LAA thrombi were even found in patients with a CHA2DS2-VASc score of 0 (n = 1) and 1 (n = 1). The presence of LAA thrombus before an elective cardioversion is a rare event in the age of direct oral anticoagulants. However, LAA thrombi occurred even in supposed low-risk individuals according to the CHA2DS2-VASc score. QRS width may aid in identifying patients at risk of reduced LAA flow velocity.

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Section: Discussionsupporting

confidence: 91%

Incidence and predictors of left atrial appendage thrombus on transesophageal echocardiography before elective cardioversion

Wegner

Radke

Ellermann

et al. 2022

Sci Rep

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“…LA thrombi are unlikely to develop after initial catheter ablation for AF rather than prior to the first session, given the significantly decreased AF burden and continuous anticoagulant use after ablation. [10][11][12] However, little is known about the prevalence of thrombus development and the requirements for imaging evaluation at repeat ablation are unclear. There is only one previous study demonstrating a 0.8% rate of thrombi detection in 263 patients who underwent repeat TEE within 365 days.…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of left atrial thrombus development in patients scheduled for repeat catheter ablation for atrial fibrillation: Is transesophageal echocardiography always mandatory?

Inden

Riku

Suga

et al. 2021

Preprint

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Introduction: The risk of developing left atrial (LA) thrombi after initial catheter ablation for atrial fibrillation (AF) and requirements for imaging evaluation for thrombi screening at repeat ablation is unclear. This study aimed to assess the occurrence of thrombus development and frequency of any imaging study evaluating thrombus formation during repeat ablation for AF. Methods: Of 2,066 patients undergoing initial catheter ablation for AF with uninterrupted oral anticoagulation, 615 patients underwent repeat ablation after 258.0 (105.0-882.0) days. We investigated which factors were associated with safety outcomes and requirements for thrombi screening. Results: All patients underwent at least one imaging examination to screen for thrombi in the first session, but the examination rate decreased to 476 patients (77%) before the repeat procedure. The frequency of imaging evaluations was 5.0%, 11%, 21%, 84%, and 91% for transesophageal echocardiography and 18%, 33%, 49%, 98%, and 99% for any imaging modality at repeat ablation performed ≤60 days, ≤90 days, ≤180 days, >180 days, and >1 year after the initial procedure, respectively. Three patients (0.5%) developed LA thrombi at repeat ablation due to identifiable causes, and no patients had thromboembolic events when no imaging evaluation was performed. Multivariate analysis revealed that repeat ablation >180 days, non-paroxysmal atrial arrhythmias, and lower left ventricular ejection fraction were predictors of the risk of thrombus development. Conclusions: The risk development of thrombus at repeat ablation for AF was low. There needs to be a risk stratification for the requirement of imaging screening for thrombi at repeat ablation for AF.

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“…Распространенность внутрисердечного тромбоза у пациентов, направленных на КА ФП, исследовалась Göldi T, et al При проведении ЧП-ЭхоКГ 1358 пациентам тромбоз ушка левого предсердия выявлен в <1% случаев. В то же время у 46% пациентов из них на момент проведения исследования сохранялся синусовый ритм, 72% принимали антикоагулянты, у 18% был низкий риск ТЭО (1 балл по шкале CHA 2 DS 2 -VASc) и у 46% регистрировалась пароксизмальная ФП [13]. Это свидетельствует о том, что регулярная антикоагулянтная терапия снижает до минимума риск внутрисердечного тромбоза.…”

Section: результаты и обсуждениеunclassified

Anticoagulant therapy in catheter ablation of atrial fibrillation and flutter

Serova

Андреев

Chashkina

et al. 2021

Cardiovasc Ther Prev

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Catheter ablation (CA) of atrial fibrillation and flutter is associated with a high risk of both perioperative thromboembolic events and bleeding. Adequate anticoagulation is imperative to reduce the risk of complications. The aim of this review was to analyze modern approaches to anticoagulant therapy for CA of atrial fibrillation and flutter, as well as provide practical information based on a comparison of current guidelines and evidence base. The search for literature sources on anticoagulant therapy in CA was carried out in the PubMed, Scopus, Web of Science databases. The results of key randomized trials and meta-analyzes are presented, and a comparison of current Russian and international guidelines is given. Unresolved issues requiring further research are discussed.

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Prevalence and Management of Atrial Thrombi in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation

Cited by 13 publications

References 27 publications

Incidence and predictors of left atrial appendage thrombus on transesophageal echocardiography before elective cardioversion

Incidence and predictors of left atrial appendage thrombus on transesophageal echocardiography before elective cardioversion

Incidence and predictors of left atrial thrombus development in patients scheduled for repeat catheter ablation for atrial fibrillation: Is transesophageal echocardiography always mandatory?

Anticoagulant therapy in catheter ablation of atrial fibrillation and flutter

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