Left Atrial Appendage Patency at Cardioversion After Surgical Left Atrial Appendage Intervention

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Surgical left atrial appendage (LAA) closure is frequently incomplete.
• Incomplete closure necessitates further management, often including direct current cardioversion (DCCV) for atrial arrhythmias.
• The impact of incomplete LAA closure on DCCV outcomes is not well understood.

Purpose of the Study:

• To evaluate the prevalence and impact of incomplete surgical LAA closure in patients undergoing DCCV.
• To assess the role of transesophageal echocardiography (TEE) in detecting LAA thrombus in this population.

Main Methods:

• Retrospective review of patients undergoing TEE-guided DCCV within 30 days of cardiac surgery and LAA closure.
• Pre-DCCV TEEs were analyzed for LAA patency and thrombus presence.

Main Results:

• 37% of patients had incomplete LAA closure.
• Thrombus was detected in 47% of patients with incomplete LAA closure, a significant risk factor (OR 4.36).
• Cardioversion was cancelled in 16% of patients due to detected thrombus.

Conclusions:

• Surgical LAA closure is often incomplete, posing a risk of thrombus formation.
• TEE is essential before DCCV in patients with prior surgical LAA intervention to assess patency and detect thrombus.
• Detecting thrombus via TEE frequently alters clinical management and necessitates DCCV cancellation.