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

Mannewald, Christine LU ; Roijer, Anders LU ; Platonov, Pyotr G. LU and Holmqvist, Fredrik LU (2024) In Annals of Noninvasive Electrocardiology 29(3).
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.... (More)

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.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
atrial fibrillation, left atrial appendage thrombus, transesophageal echocardiography
in
Annals of Noninvasive Electrocardiology
volume
29
issue
3
article number
e13119
publisher
Wiley-Blackwell
external identifiers
  • pmid:38682420
  • scopus:85191717376
ISSN
1082-720X
DOI
10.1111/anec.13119
language
English
LU publication?
yes
id
94c3b12f-7515-448c-bd5b-c0cb7fd96520
date added to LUP
2024-05-16 15:40:57
date last changed
2024-05-30 17:31:47
@article{94c3b12f-7515-448c-bd5b-c0cb7fd96520,
  abstract     = {{<p>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 CHA<sub>2</sub>DS<sub>2</sub>-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 CHA<sub>2</sub>DS<sub>2</sub>-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 CHA<sub>2</sub>DS<sub>2</sub>-VASc 0, paroxysmal AF, normal sized left atrium and sinus rhythm at TEE were found to have LAAT or SEC.</p>}},
  author       = {{Mannewald, Christine and Roijer, Anders and Platonov, Pyotr G. and Holmqvist, Fredrik}},
  issn         = {{1082-720X}},
  keywords     = {{atrial fibrillation; left atrial appendage thrombus; transesophageal echocardiography}},
  language     = {{eng}},
  number       = {{3}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Annals of Noninvasive Electrocardiology}},
  title        = {{Prevalence of left atrial appendage thrombus and spontaneous echo contrast on transesophageal echocardiography in patients scheduled for pulmonary vein isolation}},
  url          = {{http://dx.doi.org/10.1111/anec.13119}},
  doi          = {{10.1111/anec.13119}},
  volume       = {{29}},
  year         = {{2024}},
}