Left atrial appendage thrombus in patients referred to electrical cardioversion for atrial fibrillation: a prospective single-center study

Turek, Łukasz; Sadowski, Marcin; Janion−Sadowska, Agnieszka; Kurzawski, Jacek; Jaroszyński, Andrzej

doi:10.20452/pamw.16214

Cited by 5 publications

(11 citation statements)

References 39 publications

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“…These studies were published between 2016 and 2022. Among the studies, four were conducted in Poland [ 27 , 29 , 30 , 33 ], two were conducted in Japan [ 25 , 32 ], two were conducted in the United States [ 24 , 28 ], and one was conducted each in the EU [ 26 ], Germany [ 31 ], Canada [ 21 ], Turkey [ 23 ], and Italy [ 22 ]. The selected studies were mostly conducted in Western countries, and only two were conducted in an Asian population (Japan).…”

Section: Resultsmentioning

confidence: 99%

“…The selected studies were mostly conducted in Western countries, and only two were conducted in an Asian population (Japan). Six studies were prospective [ 21 , 22 , 23 , 26 , 29 , 33 ], and seven were retrospective [ 24 , 25 , 27 , 28 , 30 , 31 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…The studies included different parameters for predicting the risk of LAAT. A higher CHA2DS2-VASc score [ 22 , 23 , 25 , 33 ], reduced left ventricular ejection fraction [ 22 , 23 , 27 , 33 ], reduced left atrial flow velocity [ 23 , 25 , 30 , 32 ], reduced B-type natriuretic peptide, and larger left atrium [ 25 ] were associated with the risk of LAAT. The demographic predictors of the risk of LAAT included aging, a lower body weight, lower creatinine clearance, heart failure, and diuretic treatment were also listed.…”

Section: Resultsmentioning

confidence: 99%

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Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Cheng

Tan

Hong

et al. 2022

JCDD

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Background: Left atrial appendage thrombus (LAAT) is the main cause of cardioembolism in patients with nonvalvular atrial fibrillation (AF). Emerging evidence indicates that direct oral anticoagulants (DOACs) may be a preferred, safer choice for patients with LAAT. However, current guidelines indicate vitamin K antagonist (VKA) as the preferred treatment for LAAT. We conducted a meta-analysis to compare the efficacy of VKA and DOAC for the treatment of LAAT. Methods: The search was conducted in the PubMed, Embase, Google Scholar, and Cochrane Library databases from inception to July 2022, with the language restricted to English. A first analysis was conducted to evaluate the risk of LAAT under VKA or DOAC treatment. A second analysis was conducted to compare the resolution of LAAT under VKA and DOAC treatment. Results: In 13 studies comparing LAAT incidence rates under VKA and DOAC treatment, significant superiority of DOAC was detected (pooled RR = 0.65, 95% CI = 0.47–0.90, p = 0.009) with moderate heterogeneity being identified in the pooled studies. In 13 studies comparing LAAT resolution under VKA and DOAC use, treatment with DOAC exhibited a significantly increased probability of LAAT resolution compared with VKA (pooled odds ratio = 1.52, 95% CI = 1.02–2.26, p = 0.040). Conclusions: This meta-analysis suggests a superiority of DOAC over VKA with respect to LAAT incidence in people with AF and the likelihood of LAAT resolution. Due to their established safety profile, DOAC is a preferable choice for anticoagulation, although further randomized controlled studies are warranted to provide further evidence of their suitability as a new recommended treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Cheng

Tan

Hong

et al. 2022

JCDD

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“…The incidence of LAAT varies greatly owing to the patient's condition, and ranges from 1.2% to 22.6%; however, if adding LAA pre-thrombus conditions such as spontaneous echo contrast, the incidence will further increase. [16] Table 1 [16][17][18][19][20][21][22][23][24][25][26][27][28] summarizes the studies on the incidence of LAAT in AF patients. From August 2016 to December 2021, the incidence of LAAT diagnosed by TEE in AF patients at the Zhoupu hospital was 2.12% (23/1,086 cases).…”

Section: Incidence Of Laat In Patients With Afmentioning

confidence: 99%

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

Zhao

Zhang

2023

Cardiology Discovery

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Cardiac thrombus in patients with atrial fibrillation (AF) is most commonly found in the left atrial appendage (LAA). The incidence of LAA thrombus ranges from 1.2% to 22.6%, with the vast variation in incidence attributed to the patient’s condition. The effective rate of anticoagulation for thrombus dissolution therapy is only 50%–60%, and long-term anticoagulation treatment increases the risk of bleeding. Direct percutaneous LAA closure in AF patients with LAA thrombus in a suitable location is another alternative treatment option. LAA resection with cardiac surgery is also an effective treatment. This review presents the development of the incidence, diagnosis, and treatment of thrombus in LAA.

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“…However, many of the studies about LAA morphology or hemodynamics are retrospective, which is not so convincing for their prospective value, while the prospective studies each uses few indicators ( 15 , 16 ) and are unable to show comprehensive conclusion about whether the morphological or hemodynamic indicators are sufficient or not, let alone the question about which indicators are better for prediction. To answer these questions, we searched PubMed and CNKI for published studies.…”

Section: Introductionmentioning

confidence: 99%

Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

Sun

Chen

et al. 2023

Front. Cardiovasc. Med.

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Patients with atrial fibrillation (AF) suffer from a high risk of thrombosis. Currently, the CHA2DS2-VASc score is the most widely used tool for risk stratification in patients with AF, but it has disappointing accuracy and limited predictive value, especially in those with low scores. Thrombi in patients with AF mostly grow in their left atrial appendages (LAA), which is directly related to the abnormal morphology of the LAA or the left atrium and the unusual hemodynamic state around LAA, which may sensitively evaluate the risk of thrombosis complications in patients with AF and bring bases to clinical plans of medication and operation. Therefore, we investigated the research progress of hemodynamic and morphological studies about the predictive value of thrombosis risk in patients with AF, intending to discuss the prediction potential of morphological and hemodynamic indexes when compared with the presently used CHA2DS2-VASc system and how to build a more precise thromboembolic event prediction model for patients with AF.

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Left atrial appendage thrombus in patients referred to electrical cardioversion for atrial fibrillation: a prospective single-center study

Cited by 5 publications

References 39 publications

Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

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