Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: beyond the CHA2DS2VASc score

Abstract

INTRODUCTION Atrial fibrillation (AF) increases the risk of thromboembolic events, including ischemic stroke, by promoting clot formation in the left atrial appendage (LAA). 1 The risk of stroke in patients with AF varies widely depending on age, clinical variables, and cardiac structure or function. Accordingly, several stroke risk stratification systems for AF patients have been developed, with the CHA 2 DS 2 VASc scale being the

Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography

“…However, in our univariate analysis a reduced LAA flow and the presence of aortic valve stenosis were significant parameters. A history of nonparoxysmal AF was predictive for LAAT in this study, which is similar to the findings of Sikorska et al . In two other trials, nonparoxysmal AF was only a significant parameter in univariate analysis and lost its impact in the multivariate evaluation .…”

“…The incidence of LAAT in this study is remarkably low as compared to 1.6–10% detected in other studies . In three of these studies, patients received heparin bridging during the time of AF ablation .…”

“…The CHADS 2 and CHA 2 DS 2 ‐VASc score are already well known predictors for LAAT prior to AF ablation . Our trial shows that a CHA 2 DS 2 ‐VASc scores ≤1 is sufficient to rule out LAAT due to a 100% sensitivity and 100% negative predictive value.…”

“…In three of these studies, patients received heparin bridging during the time of AF ablation . Only one study reported a high incidence of 10% in patients treated with either continuous VKAs (116 patients) or interrupted NOACs (21 patients) …”

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

“…Most previous studies with patients on interrupted vitamin K antagonists (VKA) with heparin bridging have shown LAAT incidence of 1.6–1.9%, but much higher incidences were documented as well …”