Incidence and Predictors of Intracardiac Thrombus on Pre-electrophysiological Procedure Transesophageal Echocardiography

Rawahi, Mohamed Al; Samuel, Michelle; Galatas, Christos; Joza, Jacqueline; Lima, Pedro Y.; Barbosa, Rodrigo S.; Thanassoulis, George; Bernier, Martin; Huynh, Thao; Essebag, Vidal

doi:10.1016/j.cjco.2019.06.004

Cited by 8 publications

(13 citation statements)

References 47 publications

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“…Patients with thrombus on TOE had greater prevalence of HF (62.8% vs. 32.0%; P < 0.001) and significantly lower LVEF (50% vs. 58%; P = 0.013) 27 . HF remained an independent predictor of LAT presence (OR 2.21; 95% CI 1.04–4.71; P = 0.04), along with prior stroke and treatment with NOAC 27 …”

Section: Discussionmentioning

confidence: 94%

“…In a more recent retrospective study on 401 patients with AF (87% of patients with adequate anticoagulation) undergoing catheter ablation by Al Rawahi and coworkers, the total incidence of LAT reached 11.2% 27 . Patients with thrombus on TOE had greater prevalence of HF (62.8% vs. 32.0%; P < 0.001) and significantly lower LVEF (50% vs. 58%; P = 0.013) 27 . HF remained an independent predictor of LAT presence (OR 2.21; 95% CI 1.04–4.71; P = 0.04), along with prior stroke and treatment with NOAC 27 …”

Section: Discussionmentioning

confidence: 99%

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Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter

et al. 2022

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AimsThe aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes. Methods and resultsThe research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001). ConclusionThe diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter

et al. 2022

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“…Indeed, lower time in therapeutic range (TTR) is associated with higher rates of thromboembolism in patients on warfarin 15 . In one of the studies included in this meta‐analysis, in AF patients on warfarin undergoing CV or CA, the TTR was 36.8% in those found to have LAAT compared to 52.7% in those without LAAT 16 . Moreover, the extent of atrial cardiomyopathy, as well as other risk factors, can contribute to atrial thrombosis despite OAC 17 .…”

Section: Discussionmentioning

confidence: 99%

“…15 In one of the studies included in this meta-analysis, in AF patients on warfarin undergoing CV or CA, the TTR was 36.8% in those found to have LAAT compared to 52.7% in those without LAAT. 16 Moreover, the extent of atrial cardiomyopathy, as well as other risk factors, can contribute to atrial thrombosis despite OAC. 17 The prevalence of LAT/LAAT was much higher in patients on VKA than those on DOAC.…”

Section: Ca And/or CVmentioning

confidence: 99%

Atrial thrombus detection on transoesophageal echocardiography in patients with atrial fibrillation undergoing cardioversion or catheter ablation: A pooled analysis of rates and predictors

Noubiap

Agbaedeng

Ndoadoumgue

et al. 2021

Cardiovasc electrophysiol

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Objective: To summarize data on the rates and predictors of left atrial thrombus/ left atrial appendage thrombus (LAT/LAAT) detection by transoesophageal echocardiography (TEE) before electrical cardioversion (ECV) or catheter ablation (CA) for atrial fibrillation (AF).Methods: EMBASE, MEDLINE, and Web of Science Core Collection were searched to identify all studies providing relevant data and published by October 7, 2020.A random-effects meta-analysis method was used to pool effect size estimates.Results: A total of 85 studies were included, reporting data from 56 660 patients with AF. In patients undergoing CA and ECV, the pooled prevalence of LAT/LAAT was 1.8% and 7.5% in those not on oral anticoagulation (OAC), 1.8% and 5.5% in those taking OAC, and 1.3% and 4.

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“…Al Rawahi et al, analisando dados de 401 pacientes submetidos à ablação ou CVE, encontraram TrAE em 11,2% da amostra. Quando separamos os pacientes que usaram apenas DOACs, a presença de trombo nos que usaram dabigatrana, rivaroxabana e apixabana foi de 5%, 4% e 9%, respectivamente 19. Wu et al, analisando 609 pacientes em uso de DOAC, com tempo médio de anticoagulação de 12 semanas, encontraram 17 pacientes (2,8%) com TrAE e 15 pacientes (2,5%) com contraste espontâneo no ETE, números comparáveis aos nossos achados.…”

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Trombo Atrial Esquerdo e Contraste Espontâneo Denso no Uso de Anticoagulante Oral de Ação Direta em Fibrilação Atrial: Visão de Centro Referenciado

Marques¹,

Darrieux²,

Gouvêa³

et al. 2022

Arquivos Brasileiros De Cardiologia

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Fundamento: No tratamento da fibrilação atrial (FA), a arritmia sustentada mais frequente, com ablação por cateter (ABL) ou cardioversão elétrica (CVE), o período periprocedimento é uma das fases mais críticas. Atualmente, o uso de novos anticoagulantes orais de ação direta (DOAC) é cada vez mais frequente, no entanto, no mundo real, ainda existem poucos dados de estudos sobre a incidência de trombo no átrio esquerdo (TrAE) ou contraste espontâneo denso (CE) no ecocardiograma transesofágico (ETE). Objetivo: Analisar a prevalência de TrAE, por ETE, em pacientes em uso de DOAC submetidos à CVE/ABL. Secundariamente: avaliar a associação de comorbidades com a presença de trombos e CE. Métodos: Estudo de coorte retrospectivo, unicêntrico, com pacientes do Ambulatório de Arritmia (InCor-HCFMUSP). Foram selecionados e analisados dados clínicos e ecocardiográficos no prontuário da instituição de pacientes com indicação de procedimentos e em uso de DOACs. Considerado um nível de significância de 5%. Resultados: Foram incluídos 354 pacientes, no total de 400 procedimentos, de março de 2012-março de 2018. TrAE foi encontrado em 11 pacientes (2,8%), associado com idade avançada (p=0,007) e CHA2DS2-VASc maior (p<0,001). Foi encontrado CE no AE no procedimento antes da ETE em 29 pacientes (7,3%), com menor FEVE (p <0,038) e maior dimensão do AE (p <0,0001). Conclusão: A incidência de TrAE e CE em pacientes em uso de DOAC no contexto de CVE/ABL de FA, embora pequena, não é desprezível. Pacientes com escore CHA2DS2-VASc maior, principalmente mais idosos e com diâmetro do AE maior, são mais propensos a esses achados ecocardiográficos.

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Incidence and Predictors of Intracardiac Thrombus on Pre-electrophysiological Procedure Transesophageal Echocardiography

Cited by 8 publications

References 47 publications

Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter

Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter

Atrial thrombus detection on transoesophageal echocardiography in patients with atrial fibrillation undergoing cardioversion or catheter ablation: A pooled analysis of rates and predictors

Trombo Atrial Esquerdo e Contraste Espontâneo Denso no Uso de Anticoagulante Oral de Ação Direta em Fibrilação Atrial: Visão de Centro Referenciado

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