Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation

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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

Published on: February 26, 2013

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Antony Lurie1, Jia Wang2, Kyra J Hinnegan3

  • 1Population Health Research Institute, Hamilton, Ontario, Canada; University of Western Ontario, London, Ontario, Canada.

Journal of the American College of Cardiology
|June 11, 2021
PubMed

Insights

Left atrial (LA) thrombus prevalence is significant in patients with atrial fibrillation (AF) or atrial flutter (AFL) despite anticoagulation. Certain subgroups, like those with nonparoxysmal AF/AFL or higher CHA₂DS₂-VASc scores, show increased risk, suggesting tailored TEE use.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Pharmacology

Background:

  • Left atrial (LA) thrombus prevalence in patients with atrial fibrillation (AF) or atrial flutter (AFL) receiving anticoagulation is not well-established.
  • This knowledge gap impacts decisions regarding transesophageal echocardiogram (TEE) use prior to cardioversion or catheter ablation.

Purpose of the Study:

  • To determine the prevalence of LA thrombus in patients with AF/AFL undergoing therapeutic oral anticoagulation.
  • To identify patient subgroups at higher risk for LA thrombus.

Main Methods:

  • Systematic literature search of EMBASE, MEDLINE, and CENTRAL up to July 2020.
  • Meta-analysis of 35 studies including 14,653 patients with AF/AFL on vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs).
  • Analysis focused on LA thrombus prevalence before TEE, cardioversion, or ablation.

Main Results:

  • Overall LA thrombus prevalence was 2.73% (95% CI: 1.95% to 3.80%).
  • Prevalence was similar between VKA and DOAC users (2.80% vs. 3.12%).
  • Higher prevalence observed in nonparoxysmal AF/AFL (4.81%), patients undergoing cardioversion (5.55%), and those with CHA₂DS₂-VASc scores ≥3 (6.31%) compared to respective control groups.

Conclusions:

  • A significant prevalence of LA thrombus exists in specific subgroups of anticoagulated AF/AFL patients.
  • Routine pre-procedural TEE may be beneficial for these high-risk patient groups before cardioversion or catheter ablation.
Abstract

Keywords:
anticoagulationatrial fibrillationcardioversioncatheter ablationleft atrial thrombusprevalencetransesophageal echocardiography

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