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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Importance of the underlying substrate in determining thrombus location in atrial fibrillation: implications for left

Rajiv Mahajan1, Anthony G Brooks, Thomas Sullivan

  • 1Department of Cardiology, Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, Adelaide, SA 5000, Australia. .

Heart (British Cardiac Society)
|May 11, 2012
PubMed

Insights

Thrombus location in atrial fibrillation (AF) varies by patient type. Valvular AF patients often have thrombi outside the left atrial appendage (LAA), while non-valvular AF patients with specific conditions may also develop LAA thrombi.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Medical Research

Background:

  • The left atrial appendage (LAA) is a common site for thrombus formation in atrial fibrillation (AF).
  • Left atrial appendage occlusion is a therapeutic strategy to mitigate stroke risk in AF patients.
  • Identifying specific patient subgroups who benefit most from LAA occlusion is crucial.

Purpose of the Study:

  • To conduct a systematic review to define patient subgroups suitable for left atrial appendage closure.
  • To analyze the location of atrial thrombi in different patient populations with atrial fibrillation.

Main Methods:

  • Systematic literature search of English scientific articles using PubMed up to March 1, 2011.
  • Screening of reference lists from relevant and review articles for additional studies.
  • Inclusion of studies reporting left atrial thrombus location; exclusion of case reports with <10 thrombi.
  • Independent data extraction and quality assessment by two reviewers.

Main Results:

  • 34 studies on atrial thrombus location in AF patients were included (17 valvular AF, 10 non-valvular AF, 8 mixed).
  • Thrombi were located outside the LAA in 56% of valvular AF, 22% of mixed, and 11% of non-valvular AF patients.
  • In non-valvular AF, higher rates of left atrial cavity thrombi correlated with non-anticoagulated patients, ventricular dysfunction, and prior stroke history.

Conclusions:

  • Atrial thrombus location in AF is influenced by the underlying cardiac condition.
  • Over half of thrombi in valvular AF are found in the left atrial cavity.
  • Specific non-valvular AF subgroups (non-anticoagulated, LV dysfunction, prior stroke) show increased risk of left atrial cavity thrombi.
Abstract

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