Incidence and predictors of left atrial thrombus prior to catheter ablation of atrial fibrillation

Daniel Scherr, Darshan Dalal, Karuna Chilukuri, Jun Dong, David Spragg, Charles Henrikson, Saman Nazarian, Alan Cheng, Ronald D. Berger, Theodore P. Abraham, Hugh Calkins, Joseph E. Marine

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Left Atrial Thrombus Prior to AF Ablation. Background: Transesophageal echocardiography (TEE) is commonly used prior to catheter ablation of atrial fibrillation (AF) in order to exclude left atrial (LA) thrombus. However, the incidence and predictors of LA thrombus detected with TEE have not been systematically examined in this setting. Methods: This study included 732 cases (mean age 57 ± 11 years; 23% female; 353 persistent AF) in 585 consecutive patients referred for catheter ablation of AF. Patients were anticoagulated for at least 4 weeks prior to the procedure and then bridged with enoxaparin. TEE was performed in all cases within 24 hours prior to ablation. Results: Preprocedural TEE revealed LA thrombus in 12 of 732 cases (1.6%), all located in the LA appendage. Among these 12 patients, 9 had persistent AF and 3 had paroxysmal AF. All patients with thrombus had an LA size ≥ 4.5 cm. LA thrombus was present in 0.3%, 1.4%, and 5.3% of patients with CHADS2 scores of 0, 1, and ≥ 2, respectively. In multivariate analysis, a CHADS 2 score ≥ 2 and larger LA diameter remained significant predictors of LA thrombus. Conclusions: Despite oral anticoagulation treatment, there is a small but significant incidence of LA thrombus by TEE prior to AF ablation. A CHADS2 score ≥ 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.

Original languageEnglish (US)
Pages (from-to)379-384
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

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Catheter Ablation
Atrial Fibrillation
Thrombosis
Transesophageal Echocardiography
Incidence
Enoxaparin
Atrial Appendage
Multivariate Analysis

Keywords

  • Ablation
  • Atrial fibrillation
  • Complication
  • Echocardiography
  • Thrombus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Incidence and predictors of left atrial thrombus prior to catheter ablation of atrial fibrillation. / Scherr, Daniel; Dalal, Darshan; Chilukuri, Karuna; Dong, Jun; Spragg, David; Henrikson, Charles; Nazarian, Saman; Cheng, Alan; Berger, Ronald D.; Abraham, Theodore P.; Calkins, Hugh; Marine, Joseph E.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 4, 04.2009, p. 379-384.

Research output: Contribution to journalArticle

Scherr, D, Dalal, D, Chilukuri, K, Dong, J, Spragg, D, Henrikson, C, Nazarian, S, Cheng, A, Berger, RD, Abraham, TP, Calkins, H & Marine, JE 2009, 'Incidence and predictors of left atrial thrombus prior to catheter ablation of atrial fibrillation', Journal of Cardiovascular Electrophysiology, vol. 20, no. 4, pp. 379-384. https://doi.org/10.1111/j.1540-8167.2008.01336.x
Scherr, Daniel ; Dalal, Darshan ; Chilukuri, Karuna ; Dong, Jun ; Spragg, David ; Henrikson, Charles ; Nazarian, Saman ; Cheng, Alan ; Berger, Ronald D. ; Abraham, Theodore P. ; Calkins, Hugh ; Marine, Joseph E. / Incidence and predictors of left atrial thrombus prior to catheter ablation of atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2009 ; Vol. 20, No. 4. pp. 379-384.
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abstract = "Left Atrial Thrombus Prior to AF Ablation. Background: Transesophageal echocardiography (TEE) is commonly used prior to catheter ablation of atrial fibrillation (AF) in order to exclude left atrial (LA) thrombus. However, the incidence and predictors of LA thrombus detected with TEE have not been systematically examined in this setting. Methods: This study included 732 cases (mean age 57 ± 11 years; 23{\%} female; 353 persistent AF) in 585 consecutive patients referred for catheter ablation of AF. Patients were anticoagulated for at least 4 weeks prior to the procedure and then bridged with enoxaparin. TEE was performed in all cases within 24 hours prior to ablation. Results: Preprocedural TEE revealed LA thrombus in 12 of 732 cases (1.6{\%}), all located in the LA appendage. Among these 12 patients, 9 had persistent AF and 3 had paroxysmal AF. All patients with thrombus had an LA size ≥ 4.5 cm. LA thrombus was present in 0.3{\%}, 1.4{\%}, and 5.3{\%} of patients with CHADS2 scores of 0, 1, and ≥ 2, respectively. In multivariate analysis, a CHADS 2 score ≥ 2 and larger LA diameter remained significant predictors of LA thrombus. Conclusions: Despite oral anticoagulation treatment, there is a small but significant incidence of LA thrombus by TEE prior to AF ablation. A CHADS2 score ≥ 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.",
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AU - Scherr, Daniel

AU - Dalal, Darshan

AU - Chilukuri, Karuna

AU - Dong, Jun

AU - Spragg, David

AU - Henrikson, Charles

AU - Nazarian, Saman

AU - Cheng, Alan

AU - Berger, Ronald D.

AU - Abraham, Theodore P.

AU - Calkins, Hugh

AU - Marine, Joseph E.

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N2 - Left Atrial Thrombus Prior to AF Ablation. Background: Transesophageal echocardiography (TEE) is commonly used prior to catheter ablation of atrial fibrillation (AF) in order to exclude left atrial (LA) thrombus. However, the incidence and predictors of LA thrombus detected with TEE have not been systematically examined in this setting. Methods: This study included 732 cases (mean age 57 ± 11 years; 23% female; 353 persistent AF) in 585 consecutive patients referred for catheter ablation of AF. Patients were anticoagulated for at least 4 weeks prior to the procedure and then bridged with enoxaparin. TEE was performed in all cases within 24 hours prior to ablation. Results: Preprocedural TEE revealed LA thrombus in 12 of 732 cases (1.6%), all located in the LA appendage. Among these 12 patients, 9 had persistent AF and 3 had paroxysmal AF. All patients with thrombus had an LA size ≥ 4.5 cm. LA thrombus was present in 0.3%, 1.4%, and 5.3% of patients with CHADS2 scores of 0, 1, and ≥ 2, respectively. In multivariate analysis, a CHADS 2 score ≥ 2 and larger LA diameter remained significant predictors of LA thrombus. Conclusions: Despite oral anticoagulation treatment, there is a small but significant incidence of LA thrombus by TEE prior to AF ablation. A CHADS2 score ≥ 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.

AB - Left Atrial Thrombus Prior to AF Ablation. Background: Transesophageal echocardiography (TEE) is commonly used prior to catheter ablation of atrial fibrillation (AF) in order to exclude left atrial (LA) thrombus. However, the incidence and predictors of LA thrombus detected with TEE have not been systematically examined in this setting. Methods: This study included 732 cases (mean age 57 ± 11 years; 23% female; 353 persistent AF) in 585 consecutive patients referred for catheter ablation of AF. Patients were anticoagulated for at least 4 weeks prior to the procedure and then bridged with enoxaparin. TEE was performed in all cases within 24 hours prior to ablation. Results: Preprocedural TEE revealed LA thrombus in 12 of 732 cases (1.6%), all located in the LA appendage. Among these 12 patients, 9 had persistent AF and 3 had paroxysmal AF. All patients with thrombus had an LA size ≥ 4.5 cm. LA thrombus was present in 0.3%, 1.4%, and 5.3% of patients with CHADS2 scores of 0, 1, and ≥ 2, respectively. In multivariate analysis, a CHADS 2 score ≥ 2 and larger LA diameter remained significant predictors of LA thrombus. Conclusions: Despite oral anticoagulation treatment, there is a small but significant incidence of LA thrombus by TEE prior to AF ablation. A CHADS2 score ≥ 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.

KW - Ablation

KW - Atrial fibrillation

KW - Complication

KW - Echocardiography

KW - Thrombus

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