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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Prevalence of auricular thrombosis before atrial flutter cardioversion: a 17-year transoesophageal echocardiographic

Alberto Cresti1, Miguel Angel García-Fernández2, Francesco De Sensi3

  • 1Cardiological Department, Misericordia Hospital, via Senese, Grosseto 58100, Italy alcresti@gmail.com.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|May 29, 2015
PubMed

Insights

Atrial appendage thrombosis is common in both atrial fibrillation and flutter. Transesophageal echocardiography screening is recommended for patients with these arrhythmias lasting over 48 hours.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Diagnostic Imaging

Background:

  • Atrial fibrillation (AF) has a known prevalence of left atrial appendage thrombosis (6-18%).
  • Limited data exists on atrial thrombosis in persistent atrial flutter (AFL), with reported frequencies varying widely (1-21%).

Purpose of the Study:

  • To determine the prevalence of atrial appendage thrombosis in patients with recent onset atrial flutter (AFL) undergoing cardioversion.
  • To compare the prevalence of atrial thrombosis in AFL with that of atrial fibrillation (AF).

Main Methods:

  • A retrospective analysis of 1081 patients undergoing transesophageal echocardiography (TEE)-guided cardioversion (CV) between 1999 and 2014.
  • Patients included 877 with AF and 204 with AFL, with arrhythmias persisting for over 48 hours.
  • Evaluation included assessment of appendage thrombosis, Doppler emptying velocities, and spontaneous echo contrast (SEC).

Main Results:

  • Overall atrial thrombosis prevalence was 9.62%.
  • Atrial thrombosis occurred in 6.4% of AFL patients versus 10.5% of AF patients (P=0.074).
  • Left atrial appendage thrombosis was found in 5.9% of AFL patients and 9.9% of AF patients (P=0.07). Moderate to severe SEC was noted in 28% of AFL and 35% of AF patients (P=0.05).

Conclusions:

  • Auricular thrombosis is a significant finding in AFL prior to cardioversion.
  • TEE screening for atrial thrombosis is advisable in both AFL and AF patients presenting after more than 48 hours of arrhythmia onset.
Abstract

Keywords:
Atrial fibrillationAtrial flutterAtrial thrombosisCardioversionLeft appendageRight appendageTransoesophageal echocardiography

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