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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Electric cardioversion in patients treated with oral anticoagulants: embolic material in the left atrial appendage

Jarosław Karwowski1, Jerzy Rekosz2, Mateusz Solecki2

  • 1Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland.

Cardiovascular Journal of Africa
|December 8, 2022
PubMed

Insights

Restoring sinus rhythm in atrial fibrillation (AF) patients requires careful anticoagulant use. This study reviews treatments for left atrial appendage (LAA) thrombus despite oral anticoagulation, crucial for preventing thromboembolic events.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Pharmacology

Background:

  • Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia.
  • Restoring sinus rhythm without proper anticoagulation carries a 5-7% thromboembolic risk.
  • Oral anticoagulation (OAC) reduces embolic material formation, particularly in the left atrial appendage (LAA).

Purpose of the Study:

  • To compare the efficacy and safety of OACs in AF patients undergoing cardioversion.
  • To assess LAA thrombus formation frequency in AF patients on OACs.
  • To discuss treatment strategies for LAA thrombus resolution.

Main Methods:

  • Review of clinical trials on OACs in AF cardioversion.
  • Evaluation of LAA thrombus incidence in patients on OACs.
  • Discussion of LAA thrombus dissolution strategies.

Main Results:

  • A significant portion of AF patients develop LAA thrombus even with OAC therapy.
  • Optimal management for LAA thrombus resolution remains unclear due to limited high-powered studies.
  • Current evidence lacks definitive endpoints to guide best treatment strategies.

Conclusions:

  • LAA thrombus formation persists in some AF patients despite OAC treatment.
  • Further research is needed to establish effective and safe LAA thrombus dissolution methods.
  • Evidence-based guidelines for managing LAA thrombus in AF patients on anticoagulation are currently insufficient.

Keywords:
atrial fibrillationelectric cardioversionleft atrial appendage thrombusnon‐vitamin K antagonist oral anticoagulantstransoesophageal echocardiography

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