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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left atrial appendage thrombus in patients referred for electrical cardioversion for atrial fibrillation: a
Łukasz Turek1, Marcin Sadowski2, Agnieszka Janion-Sadowska2
1Collegium Medicum, Jan Kochanowski University, Kielce, Poland. lukasz.turek@wszzkielce.pl
Insights
Left atrial appendage thrombus (LAAT) is common in atrial fibrillation (AF) patients on anticoagulation. However, LAAT did not predict stroke, thromboembolism, or death in this cohort.
Area of Science:
- Cardiology
- Internal Medicine
- Thrombosis Research
Background:
- Left atrial appendage thrombus (LAAT) is a known stroke risk factor in atrial fibrillation (AF).
- The clinical significance of LAAT in AF patients receiving chronic oral anticoagulation (OAC) remains uncertain.
Purpose of the Study:
- To determine the prevalence and predictors of LAAT in AF patients undergoing electrical cardioversion.
- To evaluate the predictive value of LAAT for mortality, stroke, and systemic thromboembolic events.
Main Methods:
- Prospective, single-center cohort study of 296 AF patients.
- Transesophageal echocardiography performed before electrical cardioversion.
- 12-month follow-up for systemic thromboembolic events, stroke, and death.
Main Results:
- A high prevalence of LAAT (14.5%) was observed despite uninterrupted OAC.
- Predictors of LAAT included COPD, heart failure, prior MI, larger left atrial diameter, lower LVEF, and higher CHA2DS2-VASc score.
- No strokes or systemic thromboembolic events occurred during follow-up.
Conclusions:
- LAAT is prevalent in AF patients on OAC undergoing cardioversion.
- LAAT did not demonstrate predictive value for adverse outcomes in this population.
- Further research may be needed to clarify the role of LAAT in anticoagulated AF patients.
Introduction:
Left atrial appendage thrombus (LAAT) is a risk factor for stroke; however, the actual health risk associated with LAAT in patients with atrial fibrillation (AF) on chronic anticoagulation is unknown.
Objectives:
We aimed to assess the prevalence and predictors of LAAT, and its predictive role in relation to mortality, stroke, and systemic thromboembolic events among consecutive AF patients on oral anticoagulation (OAC) admitted for electrical cardioversion.
Patients And Methods:
This was a prospective, single‑ center cohort study. The participants underwent transesophageal echocardiography before electrical cardioversion. A total of 296 patients were enrolled. The primary outcome was the presence of LAAT. All participants were followed for 12 months to evaluate the incidence of systemic thromboembolic events, stroke, and death.
Results:
Despite uninterrupted OAC in patients with AF of above 48-hour duration scheduled for cardio-version, we found a high prevalence of LAAT, reaching 14.5%. There was no difference in the prevalence of thrombi between different types of OAC (P = 0.26). The independent predictors of LAAT were chronic obstructive pulmonary disease, heart failure, prior myocardial infarction, greater left atrial diameter, lower left ventricular ejection fraction, higher CHA2DS2‑VASc score, and reduced dabigatran dose. The optimal cutoff values for the prediction of LAAT were the age of at least 74 years, left atrial diameter equal or greater than 52 mm, left ventricular ejection fraction equal or lower than 40%, and CHA2DS2‑VASc score equal or greater than 3. No strokes or systemic thromboembolic events occurred over the follow‑up period.
Conclusions:
The presence of LAAT had no practical value for predicting stroke, thromboembolic events, or death in patients with AF and on chronic anticoagulation.
