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Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography.
- Source :
- Journal of Cardiovascular Electrophysiology; Oct2017, Vol. 28 Issue 10, p1127-1136, 10p
- Publication Year :
- 2017
-
Abstract
- Introduction The need for transesophageal echocardiography (TEE) before catheter ablation of atrial fibrillation (CA-AF) is still being questioned. The aim of this study is to analyze patients' (patients) risk factors of left atrial appendage thrombus (LAAT) prior to CA-AF in daily clinical practice, according to oral anticoagulation (OAC) strategies recommended by current guidelines. Methods and results All patients scheduled for CA-AF from 01/2015 to 12/2016 in our center were included and either treated with NOACs (novel-OAC; paused 24-hours preablation) or continuous vitamin K antagonists (INR 2.0-3.0). All patients received a preprocedural TEE at the day of ablation. Two groups were defined: (1) patients without LAAT, (2) patients with LAAT. The incidence of LAAT was 0.78% (13 of 1,658 patients). No LAAT was detected in patients with a CHA<subscript>2</subscript>DS<subscript>2</subscript>-VASc score of ≤1 (n = 640 patients) irrespective of the underlying AF type. Independent predictors for LAAT are: higher CHA<subscript>2</subscript>DS<subscript>2</subscript>-VASc scores (odds ratio [OR] 1.54, 95%-confidence interval [CI]: 1.07-2.23, P = 0.0019), a history of nonparoxysmal AF (OR 7.96, 95%-CI: 1.52-146.64, P = 0.049), hypertrophic cardiomyopathy (HCM; OR 9.63, 95% CI: 1.36-43.05, P = 0.007), and a left ventricular ejection fraction (LVEF) < 30% (OR 8.32, 95% CI: 1.18-36.29, P = 0.011). The type of OAC was not predictive (P = 0.70). Conclusions The incidence of LAAT in patients scheduled for CA-AF is low. Therefore, periprocedural OAC strategies recommended by current guidelines seem feasible. Preprocedural TEE may be dispensed in patients with a CHA<subscript>2</subscript>DS<subscript>2</subscript>-VASc score ≤1. However, a CHA<subscript>2</subscript>DS<subscript>2</subscript>-VASc score ≥2, reduced LVEF, HCM, or history of nonparoxysmal AF are independently associated with an increased risk for LAAT. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10453873
- Volume :
- 28
- Issue :
- 10
- Database :
- Complementary Index
- Journal :
- Journal of Cardiovascular Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 125592021
- Full Text :
- https://doi.org/10.1111/jce.13279