Prevalence of Left Atrial Thrombus Detection by Transesophageal Echocardiography

Abstract

Despite ≥4 weeks of anticoagulation, the rate of LA thrombus in patients on NOACs before catheter ablation of AF or atrial flutter was 4.4%. This suggests that continuous NOAC therapy does not eliminate the need for TEE before catheter ablation of AF.

Novel oral anticoagulant use in adult Fontan patients: A single center experience

“…However, as many as 4% of patients can have left atrial thrombus even after 4 weeks of NOAC therapy. Similar rates exist even with warfarin therapy . Thus, we do not consider the initial expansion an incidence of treatment failure.…”

“…Similar rates exist even with warfarin therapy. 29 Thus, we do not consider the initial expansion an incidence of treatment failure.…”

Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?

“…Other clinical predictors of LAAT were found in multivariate analyses of retrospective studies, such as history of nonparoxysmal AF. 4,20,23 Similar to Gunawardene et al, 20 Frenkel et al 23 have also found that persistent AF was independently associated with LAAT despite uninterrupted OAC regimens; history of congestive heart failure (CHF) was also found to be of predictive significance. Puwanant et al 7 showed in a multivariate model that history of CHF and LVEF <35% were significantly associated with sludge/thrombus, as did other studies.…”

“…21 Reers et al 22 showed a numerically lower but not significantly different frequency of any left atrium (LA) abnormality (LAAT, dense spontaneous echo contrast or low LAA velocity) under dabigatran and rivaroxaban compared with VKA. Frenkel et al 23 In contrast, Di Biase et al 24 showed in a recent prospective multicenter registry of AF patients undergoing AF ablation on uninterrupted NOACs that periprocedural stroke rate was extremely low Similar to the analysis of Gunawardene et al, 20 high CHADS 2 and CHA 2 DS 2 -VASc scores were found to be independent predictors of LAAT in multivariate analysis of previous studies as well. 5 25 showed that diabetes mellitus, CHADS 2 score ≥3 and CHA 2 DS 2 -VASc score ≥4 were independent risk predictors of LA/LAA thrombus.…”

“…Puwanant et al 7 showed in a multivariate model that history of CHF and LVEF <35% were significantly associated with sludge/thrombus, as did other studies. 23 Gunawardene et al 20 found nonclinical predictors for LAAT as well, such as EF <30% and hypertrophic cardiomyopathy. Other trials have found structural heart disease to be a predictor for LAAT.…”