Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry

Abstract

BackgroundOur aim was to assess the characteristics and to identify predictors of left atrial thrombus (LAT) in patients under age 65 with atrial fibrillation (AF) or atrial flutter (AFl).MethodsWe conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled.ResultsOf the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT (n = 76) had higher CHA2DS2-VASc score (p &amp;lt; 0.001), more frequently had non-paroxysmal AF/AFl (p &amp;lt; 0.001), heart failure (p &amp;lt; 0.001), history of diabetes mellitus (p = 0.001), transient ischemic attack (p = 0.04), coronary artery disease (p = 0.02), and chronic kidney disease (p &amp;lt; 0.001). The LAT patients were also more often smokers (p = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) (p &amp;lt; 0.001). Transthoracic echocardiography revealed a higher left atrial area (p &amp;lt; 0.001), lower left ventricular ejection fraction (LVEF) (p &amp;lt; 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients (p &amp;lt; 0.001). LVEF (OR 2.95; 95% CI: 1.32–6.59, p = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05–24.63, p = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48–9.75, p &amp;lt; 0.001) were identified as independent predictors of LAT in younger patients.ConclusionsOur study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs.

Effectiveness of Transesophageal Echocardiography in Preventing Thromboembolic Complications Before Cardioversion: A Narrative Review

“…Among the risk factors identified is the discovery of the value of speckle-tracking analysis of the left atrium wall in predicting thrombi [ 25 ]. Furthermore, a multicenter prospective observational study sourced from the left atrial thrombus TEE (LATTEE) registry highlighted that younger AFib patients with a non-paroxysmal AFib, reduced left ventricular ejection fraction (LVEF), and those treated with VKAs had a higher risk of developing LAA thrombi [ 32 ]. The CLOTS-AF scoring system considers additional factors such as creatinine, LVEF, left ventricular overload, tricuspid annular plane for systolic excursion (TAPSE), stroke, AFib rhythm for high-risk individuals with unclear AFib duration who require deferment of cardioversion in favor of anticoagulation versus low-risk candidates who are appropriate for immediate TEE-guided cardioversion [ 33 ].…”