Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias

Kosmalska, Katarzyna; Rzyman, Malgorzata; Miękus, Paweł; Gilis‐Malinowska, Natasza; Nowak, Radosław; Fijałkowski, Marcin

doi:10.5603/cj.a2019.0056

Cited by 15 publications

(8 citation statements)

References 32 publications

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“…In the academic department, all patients have TEE performed routinely before direct current cardioversion of AF or catheter ablation for AF (pulmonary vein isolation) excluding those admitted for cardioversion for emergency indications, as described previously 2,6 . In the military hospital, preprocedural TEE was performed in case of any doubt regarding the efficacy of oral anticoagulation (OAC) or patient's compliance 7,8 . In both departments, TEE was conducted within 48 hours prior to the scheduled procedure (usually directly or a few hours before the procedure).…”

Section: Methodsmentioning

confidence: 99%

Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation

Gawałko

Budnik

Uziębło‐Życzkowska

et al. 2020

Int. J. Clin. Pract.

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Introduction: Decreased left atrial appendage emptying velocity (LAAV) is a known predictor of LAA thrombus in atrial fibrillation (AF). The aim of our study was to identify which of the clinical risk factors for LAA thrombus are associated with decreased LAAV. Methods: The study included 1476 consecutive AF patients who underwent transesophageal echocardiography (TEE) before AF direct current cardioversion or ablation in two high-reference cardiology departments. Patients were divided into two groups: 71 (4.8%) patients with LAAV < 20 cm/s and 1405 patients (95%) with LAAV ≥ 20 cm/s. Results: Compared with patients with LAAV ≥ 20 cm/s, those with decreased LAAV were older, more often had non-paroxysmal AF, were burdened with more concomitant diseases (including hypertension, diabetes, vascular disease, and heart failure [HF]) with higher median CHA 2 DS 2-VASc score (3 [2-4] vs 2 [1-3], P < .0001), and had lower glomerular filtration rate (GFR). Prevalence of LAA thrombus was higher in patients with decreased LAAV compared with those with LAAV ≥ 20cm/s (20% vs 4.6%, P < .0001). In patients with decreased LAAV, there was no difference in the frequency of LAA thrombus between those treated with VKA and those receiving NOAC, while in patients with LAAV ≥ 20 cm/s a trend was observed towards a benefit with NOAC. In multivariate logistic regression, non-paroxysmal AF, HF and age ≥ 65 years predicted both LAAV < 20 cm/s and LAA thrombus, while GFR < 60 mL/min/1.73 m 2 predicted only the presence of LAA thrombus. Conclusion: One in five AF patients with decreased LAAV had LAA thrombus, regardless of the type of OAC. Non-paroxysmal AF, HF and age ≥ 65 years might increase LAA thrombus risk via reduced LAAV.

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Section: Methodsmentioning

confidence: 99%

Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation

Gawałko

Budnik

Uziębło‐Życzkowska

et al. 2020

Int. J. Clin. Pract.

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“…In patients with class I indications, the prevalence of LA thrombus was high both on VKA (13%) and on NOAC (7.6%), whereas in those with class IIa indications it was still high on VKA (11%), but much lower on NOAC (1.2%, p < 0.01). Thus, it may be suggested that patients with high thromboembolic risk (class I indications to OAC) should not be exempted from TEE before cardioversion or catheter ablation even after three weeks of OAC treatment [ 19 ]. In patients with class IIa indications to OAC, TEE before cardioversion might be reasonable in patients treated with VKA if no evidence for effective TTR is available.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry

Kapłon‐Cieślicka

Gawałko

Budnik

et al. 2022

JCM

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Background: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC). Methods: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation. Results: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p < 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p < 0.01), even after propensity score weighting (13% vs. 7.5%; p < 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p < 0.01 for both comparisons), however, not after propensity score weighting. Conclusions: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.

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“…Previous studies suggest that the incidence of left atrial appendage (LAA) thrombi or spontaneous echo contrast (SEC) is up to 29% [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of left atrial appendage thrombus in patients with atrial fibrillation and chronic kidney disease

et al. 2022

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Background: Atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with an increased risk of ischemic stroke. The aim of this study was to compare the clinical characteristics, the incidence of left atrial appendage (LAA) thrombus and its predictors, and spontaneous echo contrast (SEC) in a population of patients with AF depending on estimated glomerular filtration rate (eGFR) values. Methods: This study included 1962 patients who underwent transesophageal echocardiographic examination (TEE) prior to cardioversion or ablation in the years 2014-2018 in three cardiac centers. Results: More than a quarter of AF patients had decreased eGFR (< 60 mL/min/1.73 m 2) and were characterized as a high-risk population, with more comorbidities, higher thromboembolic and bleeding risk compared to those with normal renal function. Oral anticoagulation (OAC) was prescribed in 97% and 93% of patients with decreased and normal eGFR, respectively, with a higher prevalence of prescribed non-vitamin K antagonist oral anticoagulants (NOACs). The incidence of LAA thrombus (24%, 9% and 4%) and SEC (25%, 25% and 19%) increases simultaneously with a decrease in eGFR (< 30, 30-59 and > 60 mL/min/1.73 m 2 , respectively). Among patients prescribed reduced doses of NOAC, those with decreased eGFR were more often observed with LAA thrombus (10% vs. 2.5%). Non-paroxysmal AF, heart failure and previous bleeding were predictors of LAA thrombus, irrespective of eGFR value. CKD was the predictor of LAA thrombus in all patients including those with non-paroxysmal AF, males, without diabetes, without hypertension and with CHA2DS2-VASc < 2. Conclusions: Despite OAC, patients with concomitant AF and CKD remain at high risk for LAA thrombus formation.

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Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias

Cited by 15 publications

References 32 publications

Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation

Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation

Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry

Risk of left atrial appendage thrombus in patients with atrial fibrillation and chronic kidney disease

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