Background and aim Left ventricular thrombus is a frequent complication of myocardial infarction (MI) and heart failure with severely depressed ejection fraction. Once diagnosed, anticoagulation for up to 6-months is recommended, but clinical experience with direct oral anticoagulation (DOAC) is limited to a few case reports. Our aim is to test DOAC LV thrombus resolution efficacy against warfarin. Methods Single-centre retrospective cohort study of consecutive patients with recently diagnosed LV thrombus, either after acute myocardial infarction or heart failure with reduced ejection fraction, from January 2009 till December 2018. Thrombus diagnosis and subsequent assessments were performed with echocardiography and complemented with cardiac magnetic resonance, when appropriate. Decisions regarding the type, dose and duration of anticoagulation and any concomitant antiplatelet therapy were left to physician's judgement. Results In a population of 66 patients (51 male, mean age 69±12 years), 13 received DOAC therapy, with the remainder receiving vit. K antagonists. One from each group was lost to follow up. The DOAC subgroup had higher prevalence of atrial fibrillation, higher left ventricular end-diastolic volumes and worse wall motion severity score index (WMSI). The duration of anticoagulant therapy, concomitant single or dual antiplatelet therapy and overall follow up were similar between strategies. Thrombus remission was observed in 91.7% (n=11) and 59.6% (n=31) patients within DOAC and warfarin group, respectively. Risk of unsuccessful resolution was reduced by 35% relative to the warfarin group (RR 0.65; 95% CI [0.491–0.862]; p-value 0.035) (figure). figure Conclusion DOAC seems to be an effective alternative to vitamin-K antagonists in patients with LV thrombus.

Funding Acknowledgements Type of funding sources: None. Background Conventional right ventricular pacing induces dyssynchrony and 20% of patients may need upgrade for resynchronisation therapy (CRT). Currently, left bundle branch area pacing (LBBAP) is growing as an alternative for conventional pacing, preserving left ventricular function. Purpose We aimed to describe procedural characteristics of a group of consecutive patients submitted to LBBAP, and to compare the final QRS duration to a group of consecutive idiopathic LBB patients submitted to conventional CRT. Methods Single-centre cohort including consecutive patients submitted to LBBAP or CRT since November 2021. Feasibility, procedure and fluoroscopy times, final QRS duration during pacing immediately after implantation, and periprocedural complications were assessed. Successful implantation of LBBA pacing was defined as a left ventricular activation time (LVAT) < 90ms plus right bundle branch block pattern in V1. Results A total of 91 patients (mean age 75±11 years, 70.3% male, and 43 [47.3%] with LBBAP) were included. Total procedure (63min [50-76] vs. 91min [71-131], p<0.001) and fluoroscopy times (4.1min [2.4-6.4] vs. 13.4min [8.3-23.1], p<0.001) were significantly lower in the LBBAP vs. CRT group, respectively. In the LBBA pacing group, median LVAT was 86ms (IQR 81-94) and no cases of electrode dislocation or perforation at discharge were reported. Final QRS duration was 112ms (IQR 105-125) vs 127ms (IQR 115-143) in the LBBAP vs CRT groups respectively (p<0.001). Conclusion When compared to a group of idiopathic LBB block patients submitted to CRT, LBBAP was faster, required less fluoroscopy time and was associated with final narrower QRS. Further studies are necessary to understand its role in patients with LV dysfunction and indication for resynchronisation therapy.

No abstract

No abstract

No abstract