Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion

Barysienė, Jūratė; Žebrauskaitė, Aistė; Petrikonytė, Dovilė; Marinskis, Germanas; Aidietienė, Sigita; Aidietis, Audrius

doi:10.1186/s12872-017-0503-8

Cited by 15 publications

(17 citation statements)

References 24 publications

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“…The overall incidence of thrombus formation in our study was 4.7%. Patients without anticoagulation therapy showed highest incidence (9.5%), whereas patients under anticoagulation therapy had a lower but still remarkable rate (4.1%) being in line with findings from recent studies . We observed an apparently significant difference in the overall incidence of thrombus formation between NOAC‐ and VKA‐treated patients.…”

Section: Discussionsupporting

confidence: 91%

“…In a recent study addressing the question of factors influencing thrombus formation in patients with appropriate OAC scheduled for cardioversion, thrombi were detected in 5.8% of patients (VKA and NOAC), a rate twice as high as our findings . These patients were noted to show a higher rate of impaired LV‐function and higher CHA 2 DS 2 ‐VASc‐Scores (≥5).…”

Section: Discussionsupporting

confidence: 49%

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Incidence of intracardiac thrombus formation prior to electrical cardioversion in respect to the mode of oral anticoagulation

Schaeffer¹,

Rüden²,

Salzbrunn³

et al. 2018

Cardiovasc electrophysiol

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 49%

Incidence of intracardiac thrombus formation prior to electrical cardioversion in respect to the mode of oral anticoagulation

Schaeffer¹,

Rüden²,

Salzbrunn³

et al. 2018

Cardiovasc electrophysiol

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“…Some studies have found the CHADS 2 and CHA 2 DS 2 -VASc scores to be the strongest predictors of LAAT prior to electrical cardioversion [ 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage Thrombus Formation Despite Continuous Non-Vitamin K Antagonist Oral Anticoagulant Therapy in Atrial Fibrillation Patients Undergoing Electrical Cardioversion or Catheter Ablation: A Comparison of Dabigatran and Rivaroxaban

Gorczyca

Chrapek

Jelonek

et al. 2020

Cardiology Research and Practice

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Left atrial appendage thrombus (LAAT) may be detected by transesophageal echocardiography (TOE) in patients with atrial fibrillation (AF) despite continuous anticoagulation therapy. We examined the factors predisposing to LAAT in patients treated with the anticoagulants dabigatran and rivaroxaban. We retrospectively evaluated 1,256 AF patients from three centres who underwent TOE before electrical cardioversion (n = 611, 51.4%) or catheter ablation (n = 645, 48.6%) from January 2013 to December 2019 and had been on at least three weeks of continuous dabigatran (n = 603, 48%) or rivaroxaban (n = 653, 52%) therapy. Preprocedural TOE diagnosed LAAT in 51 patients (4.1%), including 30 patients (5%) treated with dabigatran and 21 patients (3.2%) treated with rivaroxaban (p=0.1145). In multivariate logistic regression, predictors of LAAT in patients treated with dabigatran were non-paroxysmal AF (vs. paroxysmal AF) (OR = 6.2, p=0.015), heart failure (OR = 3.22, p=0.003), and a eGFR <60 ml/min/1.73 m2 (OR = 2.65, p=0.012); the predictors in patients treated with rivaroxaban were non-paroxysmal AF (vs. paroxysmal AF) (OR = 5.73, p=0.0221) and heart failure (OR = 3.19, p=0.116). In ROC analysis of the dabigatran group, the area under the curve (AUC) for the CHA2DS2-VASc-RAF score was significantly higher (0.78) than those for the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores (0.67, 0.70, and 0.72, respectively). In the rivaroxaban group, the CHA2DS2-VASc-RAF score also performed significantly better (AUC of 0.77) than the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores (AUC of 0.66, 0.64, and 0.67, respectively). The risk of LAAT was the same for patients in both treatment groups. In all patients, non-paroxysmal AF or heart failure, and in patients treated with dabigatran an eGFR <60 ml/min/1.73 m2, were independent predictors of LAAT. The new CHA2DS2-VASc-RAF scale had the highest predictive value for LAAT in the entire study population.

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“…Other studies have reported slightly lower and higher rates of LAT in patients scheduled for ECV of AF. However, most of these studies are single-centre retrospective cohorts or had low numbers of patients 5–8 , 13 , 14 . Other randomized trials—such as the ACUTE trial, which enrolled 1222 patients with AF for ECV—included 549 patients who underwent TOE prior to ECV and found a higher rate of LAT (13.8%) 15 .…”

Section: Discussionmentioning

confidence: 99%

Determinants of left atrium thrombi in scheduled cardioversion: an ENSURE-AF study analysis

et al. 2019

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AimsENSURE-AF (NCT 02072434) was the largest prospective randomized clinical trial of anticoagulation for cardioversion in atrial fibrillation (AF), which also provides the largest prospective dataset for transoesophageal echocardiography (TOE) prior to cardioversion. This ancillary analysis investigated determinants of TOE-detected left atrium thrombi (LAT) in patients scheduled for electrical cardioversion (ECV).Methods and resultsThe ENSURE-AF multicentre PROBE evaluation trial compared edoxaban 60 mg once daily (QD) with enoxaparin/warfarin in 2199 subjects undergoing ECV of non-valvular AF. Patients were stratified by the use of TOE, anticoagulant experience, and selected edoxaban dose. Electrical cardioversion was cancelled or deferred when TOEdetected LAT. In total, 1183 subjects were stratified to the TOE arm and LAT was reported in 91 (8.2%). In univariate analysis, age ≥75 years (26.4% vs. 16.9%, P = 0.0308), lower weight (86.5 ± 15.0 vs. 90.7 ± 18.0 kg, P = 0.0309), lower creatinine clearance (80.1 ± 30.6 vs. 93.2 ± 33.9 mL/min, P = 0.0007), heart failure (59.3% vs. 43.0%, P = 0.0029), and diuretic treatment (53.9% vs. 40.1%, P = 0.0141) were more prevalent in the LAT group. Non-significant trends were seen for higher mean CHA2DS2-VASc score (3.0 ± 1.41 vs. 2.7 ± 1.48, P = 0.0571) and more prevalent anticoagulation use prior to enrolment (60.4% vs. 50.3%, P = 0.0795) in the LAT group. In logistic regression analysis, age (P = 0.0202) and heart failure (P = 0.0064) were independently associated with LAT.ConclusionElective ECV is commonly cancelled or deferred due to TOE-detected LAT in patients with non-valvular AF. Age ≥75 years and heart failure were associated with the presence of LAT.

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Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion

Cited by 15 publications

References 24 publications

Incidence of intracardiac thrombus formation prior to electrical cardioversion in respect to the mode of oral anticoagulation

Incidence of intracardiac thrombus formation prior to electrical cardioversion in respect to the mode of oral anticoagulation

Left Atrial Appendage Thrombus Formation Despite Continuous Non-Vitamin K Antagonist Oral Anticoagulant Therapy in Atrial Fibrillation Patients Undergoing Electrical Cardioversion or Catheter Ablation: A Comparison of Dabigatran and Rivaroxaban

Determinants of left atrium thrombi in scheduled cardioversion: an ENSURE-AF study analysis

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