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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Does Spontaneous Echo Contrast in the Left Atrial Appendage Increase Thromboembolism Risk After Left Atrial Appendage
Kandi Zhang1, Hanwen Yu1, Yihua Lu1
1Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Preoperative spontaneous echo contrast (SEC) in the left atrial appendage (LAA) did not increase the risk of device-related thrombosis or arterial thromboembolic events after left atrial appendage closure (LAAC) in atrial fibrillation (AF) patients.
Area of Science:
- Cardiology
- Medical Devices
- Echocardiography
Background:
- Left atrial appendage closure (LAAC) is a strategy to prevent thromboembolic events in nonvalvular atrial fibrillation (AF).
- Spontaneous echo contrast (SEC) in the left atrial appendage (LAA) is a known risk factor for LAA thrombosis.
- The association between preoperative SEC and outcomes after LAAC remains unclear.
Purpose of the Study:
- To investigate the relationship between preoperative spontaneous echo contrast (SEC) in the left atrial appendage (LAA) and the risk of device-related thrombosis (DRT) or arterial thromboembolic events (ATEs) following left atrial appendage closure (LAAC) in patients with atrial fibrillation (AF).
Main Methods:
- Retrospective analysis of 519 patients with nonvalvular AF who underwent successful LAAC.
- Transesophageal echocardiography (TEE) assessed preoperative LAA status, categorizing SEC presence (LAASEC+) versus absence (LAASEC-).
- Outcomes including DRT, ATEs, and all-cause mortality were evaluated at 1-year follow-up.
Main Results:
- No significant differences in DRT (2.5% vs. 3.8%), ATEs (0.5% vs. 0%), or all-cause mortality (2.1% vs. 2.3%) were observed between LAASEC- and LAASEC+ groups at 1 year.
- The LAASEC+ group exhibited a higher prevalence of cauliflower-type LAA morphology and LAA with 3 or more lobes.
- Preoperative LAA thrombosis or SEC did not correlate with increased DRT or ATEs post-LAAC.
Conclusions:
- Preoperative left atrial appendage spontaneous echo contrast does not appear to be a significant predictor of adverse thrombotic events or device-related thrombosis within one year after left atrial appendage closure in patients with atrial fibrillation.
- LAA morphology, specifically cauliflower type and multi-lobed structures, may be associated with the presence of preoperative SEC.
Abstract:
Background: Left atrial appendage closure (LAAC) prevents arterial thromboembolic events (ATEs) in nonvalvular atrial fibrillation (AF). Spontaneous echo contrast (SEC) is an independent risk factor for left atrial appendage (LAA) thrombosis; however, there is little knowledge about the relationship between preoperative SEC and the increased risk of device-related thrombosis (DRT) or ATEs in patients with AF who have undergone LAAC. Methods: This retrospective study focused on patients with nonvalvular AF who successfully underwent LAAC surgery. Transesophageal echocardiography (TEE) was used to assess preoperative LAA status. SEC in LAA Grades 0-2 was defined as LAASEC-, and Grades 3-4 or previously diagnosed LAA thrombus formation as LAASEC+. Results: A total of 519 AF patients (432 in LAASEC- group and 87 in LAASEC+ group) who underwent LAAC were included. At the 1-year follow-up, there was no significant difference in the incidence of DRT (2.5 vs. 3.8%, p = 0.636), ATEs (0.5 vs. 0%, p = 0.525), and all-cause mortality (2.1% vs. 2.3%, p = 0.899) between the LAASEC- group and the LAASEC+ group. However, the LAASEC+ group had higher proportions of cauliflower-type LAA and ≥ 3 lobes. Conclusions: The difference in preoperative LAA thrombosis or LAASEC was not related to the incidence of DRT or ATEs in AF patients within 1 year after LAAC.
