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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left Atrial Thrombus and Dense Spontaneous Contrast in Direct Oral Anticoagulant Therapy of Atrial Fibrillation:
Thiago Marques1, Francisco Darrieux1, Fábio Gouvêa1
1Instituto do Coração, Hospital das Clínicas , Faculdade de Medicina , Universidade de São Paulo , São Paulo , SP - Brasil.
Insights
The incidence of left atrial thrombus and dense spontaneous contrast in patients undergoing atrial fibrillation procedures with direct oral anticoagulants is not negligible. Higher CHA2DS2-VASc scores, older age, and larger left atrial size are associated with these findings.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Atrial fibrillation (AF) treatment with catheter ablation (CA) or electrical cardioversion (ECV) involves critical periprocedural phases.
- Direct oral anticoagulants (DOACs) are increasingly used, but real-world data on thrombus incidence in the left atrium (LA) or dense spontaneous contrast (DSC) on transesophageal echocardiogram (TEE) are limited.
Purpose of the Study:
- To evaluate the prevalence of LA thrombus and DSC in patients using DOACs undergoing ECV/CA.
- To analyze the association of comorbidities with the presence of thrombi and DSC.
Main Methods:
- Retrospective, single-center cohort study of patients undergoing ECV/CA while on DOACs.
- Analysis of clinical and echocardiographic data, including TEE, to identify LA thrombus and DSC.
- Statistical analysis with a significance level of 5%.
Main Results:
- Out of 354 patients (400 procedures), LA thrombus was found in 2.8% (11 patients), associated with advanced age and higher CHA2DS2-VASc scores.
- DSC in the LA was observed in 7.3% (29 patients), associated with lower left ventricular ejection fraction (LVEF) and greater LA dimension.
- Incidence of LA thrombus and DSC, though small, was not negligible.
Conclusions:
- The incidence of LA thrombus and DSC in AF patients on DOACs undergoing ECV/CA is significant.
- Higher CHA2DS2-VASc scores, older age, and larger LA dimensions are risk factors for these echocardiographic findings.
Background:
In the treatment of atrial fibrillation (AF), the most frequently sustained arrhythmia, with catheter ablation (CA) or electrical cardioversion (ECV), the periprocedural period is one of the most critical phases. Currently, the use of new direct action oral anticoagulants (DOAC) is increasingly frequent; however, in the real world, there are still few data on studies on the thrombus incidence in the left atrium (TrLA) or dense spontaneous contrast (DSC) on transesophageal echocardiogram (TEE).
Objective:
To evaluate the prevalence of events and association with risk factors in patients using DOACs. Primary objective: to analyze the prevalence of thrombus in the LA by TEE in patients using DOAC undergoing ECV/CA. Second, evaluate the association of comorbidities with the presence of thrombi and DSC.
Methods:
Retrospective cohort, single-center study with patients followed at the Arrhythmia Outpatient Unit (InCor-HCFMUSP). Patients indicated for procedures and using DOACs were selected, and their clinical/echocardiographic data were analyzed. A significance level of 5% was considered.
Results:
354 patients were included, a total of 400 procedures, from March 2012-March 2018. Thrombus in the LA was found in 11 patients (2.8%), associated with advanced age (p=0.007) and higher CHA2DS2-VASc (p<0.001) score. DSC in the LA before TEE was found in 29 patients (7.3%), with lower LVEF (p<0.038) and greater LA dimension (p<0.0001).
Conclusion:
The incidence of LA thrombus and DSC in patients using DOC in the context of AF ECV/CA, although small, is not negligible. Patients with higher CHA2DS2-VASc scores, especially older and with larger LA diameter, are more prone to these echocardiographic findings.
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