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- Title
Incidence and Predictors of Left Atrial Appendage Thrombus before Catheter Ablation of Thrombogenic Arrhythmias.
- Authors
Wegner, Felix K.; Radke, Robert M.; Ellermann, Christian; Wolfes, Julian; Willy, Kevin; Lange, Philipp S.; Frommeyer, Gerrit; Baumgartner, Helmut; Eckardt, Lars; Diller, Gerhard-Paul; Orwat, Stefan
- Abstract
Introduction: Transesophageal echocardiography (TEE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of left atrial thrombi. However, data to support this practice are inconsistent. Methods: We analyzed consecutive pre-procedural TEE in a high-volume electrophysiology center for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or LAA emptying velocity (LAAEV) < 20 cm/s. The possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results: 1676 TEE were included (1122 before pulmonary vein isolation, 436 before atrial flutter ablation, 166 before other ablations). 543 patients (32%) were female and 991 (59%) were on DOAC. Nine patients (0.5%) had an LAA thrombus on pre-procedural TEE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow. The underlying rhythm showed a significant association with the presence of LAA thrombus or reduced LAA flow (p = 0.003). Patients in sinus rhythm and cavotricuspid isthmus-dependent atrial flutter exhibited the lowest risk. Additionally, reduced kidney function was associated with a reduction in LAA flow velocities (p = 0.04). Of note, two LAA thrombi occurred in patients in sinus rhythm and six out of nine patients with an LAA thrombus were on vitamin-K antagonists. Conclusions: LAA thrombus is a rare occurrence before an elective catheter ablation. The underlying rhythm and kidney function may serve as markers of a higher likelihood of significantly reduced LAAEV and LAA thrombus.
- Subjects
ATRIAL flutter; ATRIAL arrhythmias; LEFT heart atrium; CATHETER ablation; THROMBOSIS; ARRHYTHMIA; TRANSESOPHAGEAL echocardiography
- Publication
Journal of Personalized Medicine, 2022, Vol 12, Issue 3, p460
- ISSN
2075-4426
- Publication type
Article
- DOI
10.3390/jpm12030460