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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

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

Published on: February 26, 2013

33.5K

Left atrial appendage thrombus in patients with atrial fibrillation who underwent oral anticoagulation

Jarosław Karwowski1, Jerzy Rekosz2, Renata Mączyńska-Mazuruk3

  • 1Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland. karwowski.jarek@gmail.com.

Cardiology Journal
|June 15, 2022
PubMed

Insights

Left atrial appendage thrombi occur in 7.5% of atrial fibrillation patients despite anticoagulation. Both non-vitamin K oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) showed similar thrombus prevalence, but switching to VKA may benefit patients with existing LAA thrombi.

Area of Science:

  • Cardiology
  • Thrombosis Research
  • Pharmacology

Background:

  • Atrial fibrillation (AF) cardioversion carries an embolic risk due to potential thrombi in heart cavities.
  • Oral anticoagulation is crucial for reducing thromboembolic events in AF patients.
  • Left atrial appendage (LAA) thrombi are a significant concern in AF management.

Purpose of the Study:

  • To determine the prevalence of LAA thrombi in non-valvular AF patients.
  • To compare thrombus prevalence between vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs).
  • To assess LAA thrombus persistence after treatment modification using transesophageal echocardiography (TEE).

Main Methods:

  • 160 consecutive AF patients with AF duration > 48 hours were enrolled.
  • Transesophageal echocardiography (TEE) was performed prior to cardioversion.
  • Patients were treated with either NOACs or VKAs.

Main Results:

  • LAA thrombus was identified in 7.5% of patients; spontaneous echo contrast in 11.8%.
  • Thrombus incidence was comparable between NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5%, respectively).
  • Among NOAC users, rivaroxaban, dabigatran, and apixaban showed thrombus prevalence of 8.4%, 8%, and 12.5%, respectively.

Conclusions:

  • LAA thrombi occurred in 7.5% of patients despite anticoagulation, with similar rates for NOACs and VKAs.
  • Low LAA flow velocity and a history of vascular disease independently predicted embolic material.
  • Switching to VKA may offer additional clinical benefit for patients with LAA embolic material while on NOACs.
Abstract

Keywords:
atrial fibrillationelectric cardioversionleft atrial appendage thrombusnon-vitamin K antagonist oral anticoagulantstransesophageal echocardiography

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