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. 2024 May;29(3):e13119.
doi: 10.1111/anec.13119.

Prevalence of left atrial appendage thrombus and spontaneous echo contrast on transesophageal echocardiography in patients scheduled for pulmonary vein isolation

Christine Mannewald  1 , Anders Roijer  1 , Pyotr G Platonov  1 , Fredrik Holmqvist  1
Affiliations

Prevalence of left atrial appendage thrombus and spontaneous echo contrast on transesophageal echocardiography in patients scheduled for pulmonary vein isolation

Christine Mannewald et al. Ann Noninvasive Electrocardiol. 2024 May.

Abstract

Background: To avoid causing a thromboembolic event in patients undergoing catheter ablation for atrial fibrillation (AF), patients are treated with oral anticoagulants (OAC) prior to the procedure. Despite being on anticoagulants, some patients develop a left atrial appendage thrombus (LAAT). To exclude the presence of LAAT, transesophageal ultrasound (TEE) is performed in all patients prior to the procedure. We hypothesized continuous treatment with anticoagulants would result in a low prevalence of LAAT, in patients with low CHA2DS2-VASc score.

Method: Medical records of consecutive patients planned to undergo AF ablation at Lund University Hospital during the years 2018-2020 were reviewed retrospectively. Examination protocols from transesophageal and transthoracic echocardiography were examined for LAAT and spontaneous echo contrast (SEC). Patients with LAAT and SEC were compared to patients without using Mann-Whitney U-test and Pearson Chi-squared analysis to test for correlation.

Results: Of 553 patients, three patients (0.54%) had LAAT, and 18 (3.25%) had spontaneous contrast (SEC). Patients with LAAT or SEC had a higher CHA2DS2-VASc score, more often presented in AF at TEE and less often had a normal sized left atrium.

Conclusion: There is a low prevalence of LAAT and SEC in patients with AF scheduled for pulmonary vein isolation. Patients with SEC or LAAT tend to have paroxysmal AF less often and more often presented in AF at admission. No patients with CHA2DS2-VASc 0, paroxysmal AF, normal sized left atrium and sinus rhythm at TEE were found to have LAAT or SEC.

Keywords: atrial fibrillation; left atrial appendage thrombus; transesophageal echocardiography.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

    1. Alqarawi, W. , Birnie, D. H. , Spence, S. , Ramirez, F. D. , Redpath, C. J. , Lemery, R. , Nair, G. M. , Nery, P. B. , Davis, D. R. , Green, M. S. , Beauchesne, L. , Chan, K. , Ascah, K. , Burwash, I. , & Sadek, M. M. (2019). Prevalence of left atrial appendage thrombus detected by transoesophageal echocardiography before catheter ablation of atrial fibrillation in patients anticoagulated with non‐vitamin K antagonist oral anticoagulants. Europace, 21(1), 48–53. - PubMed
    1. Anselmino, M. , Garberoglio, L. , Gili, S. , Bertaglia, E. , Stabile, G. , Marazzi, R. , Themistoclakis, S. , Solimene, F. , Frea, S. , Grosso Marra, W. , Morello, M. , Scaglione, M. , De Ponti, R. , & Gaita, F. (2017). Left atrial appendage thrombi relate to easily accessible clinical parameters in patients undergoing atrial fibrillation transcatheter ablation: A multicenter study. International Journal of Cardiology, 241, 218–222. - PubMed
    1. Cappato, R. , Calkins, H. , Chen, S. A. , Davies, W. , Iesaka, Y. , Kalman, J. , Kim, Y. H. , Klein, G. , Natale, A. , Packer, D. , Skanes, A. , Ambrogi, F. , & Biganzoli, E. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 3(1), 32–38. - PubMed
    1. Chen, J. , Zhou, M. , Wang, H. , Zheng, Z. , Rong, W. , He, B. , & Zhao, L. (2022). Risk factors for left atrial thrombus or spontaneous echo contrast in non‐valvular atrial fibrillation patients with low CHA2DS2‐VASc score. Journal of Thrombosis and Thrombolysis, 53(2), 523–531. - PubMed
    1. Di Biase, L. , Briceno, D. F. , Trivedi, C. , Mohanty, S. , Gianni, C. , Burkhardt, J. D. , Mohanty, P. , Bai, R. , Gunda, S. , Horton, R. , Bailey, S. , Sanchez, J. E. , Al‐Ahmad, A. , Hranitzky, P. , Gallinghouse, G. J. , Reddy, Y. M. , Zagrodzky, J. , Hongo, R. , Beheiry, S. , … Natale, A. (2016). Is transesophageal echocardiogram mandatory in patients undergoing ablation of atrial fibrillation with uninterrupted novel oral anticoagulants? Results from a prospective multicenter registry. Heart Rhythm, 13(6), 1197–1202. - PubMed

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