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

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Risk of Cardiovascular Complications in Patients with Persistent Atrial Fibrillation after Dissolution of a Thrombus

E S Mazur1, V V Mazur1, N D Bazhenov1

  • 1Tver State Medical University, Tver.

Kardiologiia
|June 11, 2021
PubMed

Insights

Patients with persistent atrial fibrillation (AF) and resolved left atrial appendage (LAA) thrombi face a significantly higher risk of cardiovascular complications (CVC) compared to those without LAA thrombosis. This includes increased risks of stroke and myocardial infarction.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Thrombosis Research

Background:

  • Persistent atrial fibrillation (AF) is associated with an increased risk of thromboembolic events.
  • Left atrial appendage (LAA) thrombosis is a known complication in AF patients.
  • Understanding the long-term cardiovascular risk after LAA thrombus resolution is crucial for patient management.

Purpose of the Study:

  • To compare the incidence of cardiovascular complications (CVC) in patients with persistent AF following left atrial appendage (LAA) thrombus dissolution versus those without LAA thrombosis.
  • To assess the specific risks of ischemic stroke, myocardial infarction (MI), and other adverse outcomes in these patient groups.

Main Methods:

  • A cohort study comparing 43 patients with resolved LAA thrombosis (main group) to 123 patients without LAA thrombosis (control group), stratified by CHA2DS2‑VASc score.
  • Transesophageal echocardiography was used for LAA thrombosis diagnosis and monitoring.
  • Follow-up duration was approximately 47.3 months, recording all-cause mortality, stroke, bleeding, and MI.

Main Results:

  • The main group experienced significantly higher rates of unfavorable clinical outcomes (39.5% vs. 3.3%, p<0.001).
  • Higher incidence of ischemic stroke (RR, 12.9) and myocardial infarction (MI) (RR, 5.72) was observed in the main group.
  • Stroke incidence rapidly increased in the first year post-thrombus dissolution.

Conclusions:

  • Patients with persistent AF and resolved LAA thrombi have a substantially elevated risk of CVC.
  • The findings underscore the need for vigilant monitoring and potentially intensified anticoagulation strategies in patients with a history of LAA thrombosis.

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