Prevalence of Left Atrial Appendage Thrombus in Patients Anticoagulated With Direct Oral Anticoagulants: Systematic Review and Meta-analysis

Alqarawi, Wael; Grose, Elysia; Ramirez, F. Daniel; Sikora, Lindsey; Golian, Mehrdad; Nair, Girish M.; Nery, Pablo B.; Klein, Andres; Davis, Darryl R.; Green, Martin S.; Redpath, Calum J.; Birnie, David H.; Burwash, Ian G.; Sadek, Mouhannad M.

doi:10.1016/j.cjco.2020.12.012

Cited by 7 publications

(2 citation statements)

References 26 publications

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“…Previously published meta-analyses have reported a higher prevalence of LAA thrombus in patients undergoing cardioversion. 16,17 Similar to the previously published reports, our results suggest that the incidence of peri-procedural stroke following AF ablation remains low. 8,18 However, an interesting finding of our study is the development of peri-procedural stroke in a patient with unremarkable pre-ablation CT.…”

Section: Peri-procedural Cvesupporting

confidence: 90%

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

Akhtar

Wallace

Daimee

et al. 2021

Cardiovasc electrophysiol

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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).Disclosure: Dr. Arbab-Zadeh discloses research grant support from Canon Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.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.

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Section: Peri-procedural Cvesupporting

confidence: 90%

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

Akhtar

Wallace

Daimee

et al. 2021

Cardiovasc electrophysiol

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show abstract

“…[14] In another meta-analysis highlighting the prevalence of LAAT in patients with AF, patients who underwent transesophageal echocardiogram (TEE) after at least 3 weeks of anticoagulation on NOACs had a pooled prevalence of LAAT of 2.5%, while the prevalence in the pre-AF ablation group was 1.1%, and in the pre-cardioversion group was 4.0%. [15] TEE is the gold standard for the diagnosis of LAAT. The incidence of LAAT varies greatly owing to the patient’s condition, and ranges from 1.2% to 22.6%; however, if adding LAA pre-thrombus conditions such as spontaneous echo contrast, the incidence will further increase.…”

Section: Incidence Of Laat In Patients With Afmentioning

confidence: 99%

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

Zhao

Zhang

2023

Cardiology Discovery

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Cardiac thrombus in patients with atrial fibrillation (AF) is most commonly found in the left atrial appendage (LAA). The incidence of LAA thrombus ranges from 1.2% to 22.6%, with the vast variation in incidence attributed to the patient’s condition. The effective rate of anticoagulation for thrombus dissolution therapy is only 50%–60%, and long-term anticoagulation treatment increases the risk of bleeding. Direct percutaneous LAA closure in AF patients with LAA thrombus in a suitable location is another alternative treatment option. LAA resection with cardiac surgery is also an effective treatment. This review presents the development of the incidence, diagnosis, and treatment of thrombus in LAA.

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Predictors of left atrial appendage thrombus in atrial fibrillation patients undergoing cardioversion

Ruzieh,

Bai,

Meisel

et al. 2024

J Interv Card Electrophysiol

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Prevalence of Left Atrial Appendage Thrombus in Patients Anticoagulated With Direct Oral Anticoagulants: Systematic Review and Meta-analysis

Cited by 7 publications

References 26 publications

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

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

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

Predictors of left atrial appendage thrombus in atrial fibrillation patients undergoing cardioversion

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