Prevalence and Management of Atrial Thrombi in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation.

Göldi, Tobias; Krisai, Philipp; Knecht, Sven; Aeschbacher, Stefanie; Spies, Florian; Zeljkovic, Ivan; Kaufmann, Beat A; Schaer, Beat; Conen, David; Reichlin, Tobias; Osswald, Stefan; Sticherling, Christian; Kühne, Michael (2019). Prevalence and Management of Atrial Thrombi in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation. JACC Clinical electrophysiology, 5(12), pp. 1406-1414. Elsevier 10.1016/j.jacep.2019.09.003

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OBJECTIVES This study aimed to investigate the prevalence and management of left atrial (LA) thrombi detected by transesophageal echocardiography (TEE) in patients with atrial fibrillation undergoing pulmonary vein isolation (PVI). BACKGROUND Little data are available on LA thrombi before PVI. METHODS All patients scheduled for PVI between April 2010 and April 2018 undergoing pre-procedural TEE were analyzed. Management of LA thrombus was at the discretion of the treating physician. RESULTS In this study, 1,753 pre-procedural TEE from 1,358 patients (mean age 61 ± 10 years, 28% female) were included. Anticoagulation was used in 86% of all TEE (51% with direct oral anticoagulants [DOAC], 35% with vitamin K antagonists [VKA]). Thrombi were found in 11 TEE (0.6%), all in the LA appendage. Of the 11 patients with a thrombus, 5 (46%) had paroxysmal atrial fibrillation, 2 (18%) had a CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age ≥75 Years, Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack or Thromboembolism, Vascular Disease, Age 65 to 74 Years, Sex) score of 1, and 5 (46%) were in sinus rhythm at the time of TEE. Of the 8 patients (72%) on anticoagulation therapy, 5 were treated with DOAC and 3 with VKA. Starting anticoagulation (n = 3), switching to VKA with a target international normalized ratio of 2.5 to 3 (n = 3), or switching to a DOAC (n = 1) or a different DOAC (n = 4) resulted in thrombus resolution in 9 of 11 patients (82%). CONCLUSIONS In patients with atrial fibrillation scheduled for PVI, LA thrombi are rare and present in <1%. Thrombi were found in patients on VKA and DOAC, in low-risk patients, and despite sinus rhythm. Thrombus resolution was achieved in the majority of patients by changing the anticoagulation regimen.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2405-5018

Publisher:

Elsevier

Language:

English

Submitter:

Andrea Stettler

Date Deposited:

27 Dec 2019 15:43

Last Modified:

27 Dec 2019 15:50

Publisher DOI:

10.1016/j.jacep.2019.09.003

PubMed ID:

31857039

Uncontrolled Keywords:

left atrial appendage thrombus pulmonary vein isolation transesophageal echocardiography

BORIS DOI:

10.7892/boris.137645

URI:

https://boris.unibe.ch/id/eprint/137645

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