Diagnosis of left atrial appendage thrombus in patients with atrial fibrillation: delayed contrast-enhanced cardiac CT

Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03–1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05–1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.

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Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation in the Era of Direct Oral Anticoagulants

Circulation Journal ◽

10.1253/circj.cj-18-0398 ◽

2018 ◽

Vol 82 (11) ◽

pp. 2715-2721 ◽

Cited By ~ 7

Author(s):

Masahide Harada ◽

Masayuki Koshikawa ◽

Yuji Motoike ◽

Tomohide Ichikawa ◽

Kunihiko Sugimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Atrial Fibrillation Ablation ◽

Atrial Appendage ◽

Left Atrial Appendage Thrombus

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P4731Procedure-related acute thrombosis after surgical left atrial appendage occlusion for atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.1107 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Inoue ◽

T Shimizu ◽

A Yoshimoto ◽

Y Suematsu

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Cardiac Ct ◽

Left Atrial Appendage ◽

Thrombus Formation ◽

Atrial Appendage ◽

Full Cohort ◽

Exact Test ◽

Acute Thrombosis ◽

Laa Closure

Abstract Background/Introduction Left atrial appendage (LAA) occlusion is an effective strategy for thromboembolism prevention in patients with atrial fibrillation (AF), and the novel methods of occlusion is various. The acute thrombosis after percutaneous LAA occlusion devices has been recently reported, but thrombus formation after surgical LAA occlusion is still unclear. Purpose This study aimed to analyse the incidence and prognosis of thrombus formation on closure stump line in patients with AF who underwent surgical LAA occlusion. Methods This study retrospectively analised the data from patients treated with two methods of surgical LAA closure, resection or clipping, from January 2014 to November 2018. Results A total of 187 consecutive patients with AF underwent surgical LAA closure (31 clipping and 156 stapler resection). 170 patients (91%) underwent cardiac CT for LAA imaging on postoperative day 2. The incidence of acute procedure-related thrombus formation in full cohort was 19% (35 cases). The incidence of acute thrombus in patients with clipping and resection was 19% and 16%, respectively (Fisher's exact test, p=0.8). All of 35 patients who had thrombus on LAA closure stump line underwent cardiac CT again 3 months after the primary CT. In all patients with secondary cardiac CT, thrombus on LAA closure stump line disappeared. No symptomatic thromboembolism occurred during the follow-up from operation to secondary CT scan. Conclusion(s) Thrombus formation on stump after surgical LAA closure may often occur on acute phase. The optimal LAA imaging and anti-coagulation therapy after surgical LAA occlusion will prevent patients with acute thrombus from thromboembolism.

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