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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Prevalence and Rate of Resolution of Left Atrial Thrombus in Patients with Non-Valvular Atrial Fibrillation: A

Pompilio Faggiano1, Elisabetta Dinatolo1,2, Antonella Moreo3

  • 1Fondazione Poliambulanza, 25124 Brescia, Italy.

Journal of Clinical Medicine
|March 25, 2022
PubMed

Insights

Left atrial appendage (LAA) thrombus occurs in 3% of patients with non-valvular atrial fibrillation (NVAF). Two-thirds of LAA thrombi resolved with anticoagulation, with no significant difference between NOACs and other agents.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Thrombosis Research

Background:

  • Left atrial appendage (LAA) thrombosis is a significant complication of non-valvular atrial fibrillation (NVAF).
  • A persistent thromboembolic risk exists despite anticoagulant therapy.
  • Limited data exists on LAA thrombus prevalence and resolution rates after standard anticoagulation.

Purpose of the Study:

  • To determine the prevalence of LAA thrombus in an unselected patient cohort.
  • To investigate the resolution rate of LAA thrombus following anticoagulation.
  • To identify predictors of LAA thrombus resolution.

Main Methods:

  • Retrospective analysis of 8888 transesophageal echocardiograms (TEEs) over five years.
  • Inclusion of all patients diagnosed with LAA thrombus.
  • Comparison of thrombus resolution rates across different anticoagulant therapies (VKA, heparin, NOACs).

Main Results:

  • LAA thrombus was identified in 3% (265/8888) of patients, predominantly with atrial fibrillation (97%).
  • 67% of LAA thrombi resolved in patients with follow-up TEEs.
  • No statistically significant difference in resolution rates was observed between vitamin K antagonists (VKAs), heparin, and non-vitamin K antagonist oral anticoagulants (NOACs).
  • Higher LAA emptying velocities emerged as the sole predictor of thrombus resolution.

Conclusions:

  • LAA thrombus prevalence is low but significant in NVAF patients.
  • Anticoagulation therapy, including NOACs, achieves thrombus resolution in approximately two-thirds of cases.
  • Higher LAA emptying velocity is crucial for thrombus resolution, with implications for procedures like cardioversion and ablation.
Abstract

Keywords:
atrial fibrillationdirect oral anticoagulantsheparinleft atrial appendage thrombusvitamin K antagonist

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