Risk of left atrial appendage thrombus in older patients with atrial fibrillation

Abstract

IntroductionWe aimed to compare the prevalence of left atrial appendage (LAA) thrombus and its predictors between old and young patients with atrial fibrillation (AF).Material and methodsThe study included 1970 patients aged ≥ 65 (n = 822 [41.7%]) and < 65 (n = 1148 [58.3%]) referred for AF cardioversion or ablation preceded by transoesophageal echocardiography (TEE).ResultsOral anticoagulation (OAC) was prescribed in 799 (97.2%) patients aged ≥ 65 years and in 1054 (91.8%) of those aged < 65 years (p < 0.001). In patients treated with OAC, those aged ≥ 65 years less often received vitamin K antagonist (VKA) (267 [33.4%] vs. 416 [39.5%]) and more often non-VKA-OAC (NOAC) (532 [66.6%] vs. 638 [60.5%], p = 0.008, p = 0.008) compared to patients < 65 years. On TEE, LAA thrombus was more often observed in patients aged ≥ 65 years than those aged < 65 years (63 [7.7%] vs. 46 [4.0%], p < 0.001), with an absolute but not statistically significant difference between patients aged 65–74 and ≥ 75 years (47 [7.3%] vs. 16 [8.8%], p = 0.528). In patients aged ≥ 65 years, there was no difference in the prevalence of LAA thrombus between patients treated with VKA and NOAC, in contrast to patients aged < 65 years, in whom such a difference was observed (27 [6.5%] vs. 16 [2.5%], p = 0.002). In multivariate logistic regression, predictors of LAA thrombus in both age groups were older age, non-paroxysmal AF, and heart failure, whereas only in patients aged < 65 years – VKA use, and in those aged ≥ 65 years – lower glomerular filtration rate and platelet count.ConclusionsDespite OAC use, older patients with AF remain at high risk of LAA thrombus formation. Older age, non-paroxysmal AF, and heart failure are predictors of LAA thrombus, irrespective of age.

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

“…As expected, the LAT prevalence was less frequent in younger patients with AF and AFl than in older patients with AF/AFl, in agreement with previous studies ( 8 , 14 ). Subjects under age 65 who were burdened with cardiovascular comorbidities, such as HF, DM, previous transient ischemic attack (TIA), coronary artery disease, and CKD, were more likely to have LAT.…”

“…Only single reports have been made to describe predictors of left atrial thrombus (LAT) in younger AF patients. No consensus has yet been reached regarding whether thromboembolic risk in these subjects should be estimated based only on approved models for the general AF population ( 8 ). The aim of this study was to identify LAT predictors achievable before transesophageal echocardiography (TEE) in AF/AF flutter (AFl) patients under age 65.…”