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Incidence and Predictors of Intracardiac Thrombus on Pre-electrophysiological Procedure Transesophageal

Mohamed Al Rawahi1,2, Michelle Samuel1, Christos Galatas1,3

  • 1McGill University Health Center, Division of Cardiology, Montreal, Quebec, Canada.

CJC Open
|March 12, 2020
PubMed

Insights

Left atrial appendage (LAA) thrombus affects over 11% of patients with atrial fibrillation (AF) or atrial flutter (AFl) before procedures, even when anticoagulated. Prior stroke and heart failure increase risk, while direct oral anticoagulants may reduce it.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Cerebral thromboembolism is a serious complication of atrial fibrillation (AF) and atrial flutter (AFl).
  • Transesophageal echocardiogram (TEE) use before electrophysiological procedures in anticoagulated patients varies.
  • Left atrial appendage (LAA) thrombus detection is crucial for stroke prevention.

Purpose of the Study:

  • Determine the incidence of LAA thrombus on TEE in AF/AFl patients before electrical cardioversion or ablation.
  • Identify predictors of LAA thrombus in this patient population.

Main Methods:

  • Reviewed TEEs of 401 patients undergoing electrical cardioversion, AF, or AFl ablation.
  • Collected clinical and echocardiographic variables.
  • Utilized multivariate logistic regression to identify thrombus predictors.

Main Results:

  • 11.2% of patients had LAA thrombus on TEE.
  • Incidence was higher in warfarin users (21%) versus direct oral anticoagulant (DOAC) users (6.4%).
  • Prior stroke and heart failure were predictors of LAA thrombus; DOAC use was associated with reduced odds.

Conclusions:

  • LAA thrombus is present in a significant proportion of AF/AFl patients despite anticoagulation.
  • Patients with heart failure and prior stroke may benefit from preprocedural TEE.
  • TEE can identify high-risk patients for LAA thrombus before cardioversion or ablation.
Abstract

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