Comparison of prevalence and management of left atrial appendage thrombi under old and new anticoagulants prior to left atrial catheter ablation

The prevalence and management of left atrial appendage (LAA) thrombi associated with new anticoagulants remain to be elucidated, especially prior to atrial fibrillation (AFib) ablation. This study sought to (1) compare the prevalence of LAA thrombi and/or severe LAA contrast under vitamin K antagoni...

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Bibliographic Details
Published in:The American heart journal 2017-11, Vol.193, p.8-15
Main Authors: Da Costa, Antoine, Delolme, Clarisse, Guichard, Jean Baptiste, Gerbay, Antoine, Pierrard, Romain, Romeyer-Bouchard, Cécile, Isaaz, Karl
Format: Article
Language:English
Subjects:
Ablation
Age
Aged
Anticoagulants
Anticoagulants - therapeutic use
Atrial Appendage
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - surgery
Blood clots
Cardiac arrhythmia
Catheter Ablation
Catheters
Echocardiography
Echocardiography, Transesophageal
Female
Fibrillation
Flow velocity
Follow-Up Studies
France
Heart
Heart Diseases - epidemiology
Heart Diseases - etiology
Heart Diseases - therapy
Humans
Male
Medical instruments
Middle Aged
Morphology
Patients
Preoperative Care - methods
Prevalence
Prognosis
Radiofrequency ablation
Regression analysis
Retrospective Studies
Risk Factors
Studies
Thromboembolism
Thrombosis
Thrombosis - epidemiology
Thrombosis - etiology
Thrombosis - therapy
Tomography, X-Ray Computed
Ventricle
Vitamin K
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Description
Summary:The prevalence and management of left atrial appendage (LAA) thrombi associated with new anticoagulants remain to be elucidated, especially prior to atrial fibrillation (AFib) ablation. This study sought to (1) compare the prevalence of LAA thrombi and/or severe LAA contrast under vitamin K antagonist (VKA) agents and novel oral anticoagulants (NOACs), (2) evaluate the rate of LAA thrombus resolution after anticoagulation modification, and (3) determine the predictive factors of LAA thrombi and severe LAA contrast in patients prior to LA AFib ablation. Between January 2013 and March 2016, 576 consecutive patients referred for AFib ablation were included, and the prevalence of transesophageal echocardiography–detected thrombi was similar under NOACs (2.1%) and VKA agents (2.6%). Thrombus resolution was obtained in 50% of cases following anticoagulation modification. Through multivariate exact logistic regression analysis with relevant clinical and echocardiographic features, age (P
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2017.07.016