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Left atrial appendage thrombi relate to easily accessible clinical parameters in patients undergoing atrial
Matteo Anselmino1, Lucia Garberoglio1, Sebastiano Gili1
1Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, University of Turin, Italy.
Insights
Transesophageal echocardiography (TEE) may be avoidable for some patients undergoing atrial fibrillation (AF) ablation. Patients in sinus rhythm with a CHA2DS2-VASc score of 0-1 showed no left atrial or appendage thrombi.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Transesophageal echocardiography (TEE) is standard before atrial fibrillation (AF) transcatheter ablation to detect left atrial (LA) or LA appendage (LAA) thrombi.
- Identifying patients who can safely avoid TEE could streamline the ablation procedure.
Purpose of the Study:
- To evaluate if readily available clinical parameters can predict the absence of LA/LAA thrombi.
- To identify patients who might not require pre-procedural TEE for AF ablation.
Main Methods:
- Retrospective analysis of 1539 patients undergoing TEE before AF ablation.
- Collected data included clinical features, CHA2DS2-VASc score, and TEE findings.
- Exclusion criteria included specific cardiomyopathies and prior heart surgery.
Main Results:
- A low prevalence of thrombi (0.8%) was observed in the study population.
- Sinus rhythm (SR) at TEE was independently associated with the absence of thrombi (OR 5.15).
- No patients with a CHA2DS2-VASc score of 0-1 and SR on admission had thrombi (100% specificity).
Conclusions:
- The prevalence of LA/LAA thrombi is low in selected patients undergoing AF ablation.
- Patients in SR with a CHA2DS2-VASc score of 0-1 represent a subgroup who may safely forgo pre-procedural TEE.
Background:
Transesophageal echocardiography (TEE) is routinely performed before atrial fibrillation (AF) transcatheter ablation to exclude the presence of left atrial (LA) or LA appendage (LAA) thrombi. The aim of the study is to evaluate if easily accessible clinical parameters may relate to the presence of LA or LAA thrombi to identify patients who could potentially avoid TEE.
Methods And Results:
Between January 2012 and September 2014, data from 1539 consecutive patients undergoing TEE, as a work-up before AF transcatheter ablation, in six large volume centers were collected. Baseline clinical features, CHA2DS2-VASc score, transthoracic echocardiography and presence of thrombi at TEE were recorded. Exclusion criteria were valvular, hypertrophic or dilated cardiomyopathy, previous heart surgery or an ejection fraction ≤35%. Mean age was 59.6±10.4years, 1215 (78.9%) were males; 951 (62.9%) presented in sinus rhythm (SR) on admission, 324 (21.1%) had undergone at least one previous ablation and 900 (58.5%) had CHA2DS2-VASc score 0-1. Thrombi were encountered in 12 patients (0.8%). SR at TEE independently related to the absence of thrombi (OR 5.15, 95% CI 1.38-19.02, p=0.015); in addition to this, no patient with a CHA2DS2-VASc score 0-1 and SR on admission presented thrombi at TEE (specificity 100%, p=0.011).
Conclusion:
In a selected population of patients referred for AF ablation, LA/LAA thrombi prevalence is low. No patients in SR with CHA2DS2-VASc score 0-1 presented LAA thrombi at TEE, identifying a significant subset of patients who could potentially safely be spared from pre-procedural TEE.