Incidence and Predictors of Left Atrial Thrombus Prior to Catheter Ablation of Atrial Fibrillation

Abstract

Despite oral anticoagulation treatment, there is a small but significant incidence of LA thrombus by TEE prior to AF ablation. A CHADS(2) score >or= 2 and larger LA diameter are independent predictors of LA thrombus in this patient population, while type of AF or rhythm at the time of TEE is not. The risk of LA thrombus is low in patients with a CHADS(2) score of 0 and in patients with an LA diameter < 4.5 cm.

Split-Bolus Single-Phase Cardiac Multidetector Computed Tomography for Reliable Detection of Left Atrial Thrombus: Comparison to Transesophageal Echocardiography

“…In two patients with detected SEC in TEE, no contrast abnormalities were detected in MDCT. The incidence of left atrial SEC rises with an increasing CHADS2 score which is in line with previous data from Scherr et al [21]. The pre-saturation of the blood pool within the double-phase injection protocol consistently showed high HU attenuation values in the LAA region.…”

“…Spontaneous echo contrast (SEC) in TEE is a common finding and can be found especially in patients with AF due to local circulatory stasis in the LA/LAA region [21,22,26]. It has to be considered that SEC is by definition not identical to thrombus formation in TEE and is therefore not a contraindication for the ablation procedure.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…796,812,813 The probability of identifying a thrombus was related to the CHA 2 DS 2 -VASc score in some but not in every case. Other risk factors for thrombus were LA size and a history of persistent AF.…”

“…796,797,798,799 ACE lesions have also been observed after AF ablation. 800 The prothrombotic state associated with AF ablation results in a higher, but transient, thromboembolism risk in patients with AF who were identified as low-risk before ablation.…”

“…242,489,503,532,533,655,673,796,798,799,806,920,921,1202,1203,1204 More than two-thirds of the clinical trials reviewed for preparation of this document reported one or more cerebrovascular events. Thromboembolic events typically occur within 24 hours of the ablation procedure, with the high-risk period extending for the first 2 weeks following ablation.…”