Outcome of Anticoagulation Therapy of Left Atrial Thrombus or Sludge in Patients With Nonvalvular Atrial Fibrillation or Flutter

Background: The study was to evaluate the value of CHADS2 and CHADS2VASC scores on predicting left atrial (LA) thrombus in the patients with atrial fibrillation (AF). Methods and Results: All the non-valvular AF patients undergoing AF ablation from June 2010 to June 2012 were included and divided into two groups: patients without anticoagulation and with Coumadin anticoagulation for at least 4 weeks. The relationship between CHADS2 and CHADS2VASC scores and LA thrombus as identified on transesophageal echocardiography (TEE) was analyzed prior to ablation. A total of 397 patients underwent pre-ablation TEE: 212 patients without anticoagulation, and 185 with anticoagulation. There were no differences in the CHADS2 and CHADS2VASC scores in the two groups. LA thrombus was present in 15.6% and 5.9% for the patients without anticoagulation and for those with anticoagulation, respectively (p = 0.002). There was a strong association between CHADS2 and LA thrombus, and between CHADS2VASC and LA thrombus in the two groups. No thrombus was identified in patients with CHADS2VASC score of 0 in both groups. However, thrombus was detected in 3.5% of patients with CHADS2 score of 0 in the group without anticoagulation, while no thrombus was present in the ones with anticoagulation. CHADS2VASC score of ≥1 (r=2.03, p = 0.04) was the only factor independently associated with LA thrombus in patients without anticoagulation, while both CHADS2VASC score of ≥2 (r=2.61, p=0.02) and CHADS2 score of ≥2 (r=2.73, p=0.01) were independently associated with LA thrombus. Further analyses showed that CHADS2VASC score was a better predictor for LA thrombus than CHADS2 score in patients without anticoagulation. However, there was no difference between the two scoring systems in predicting LA thrombus in patients with anticoagulation. Conclusions: LA thrombus was associated with CHADS2VASC and CHADS2 scores in non-valvular AF patients without anticoagulation. CHADS2VASC score was a better predictor than CHADS2 score for LA thrombus in patients without anticoagulation. The data suggested that it might be unnecessary to undergo a TEE evaluation for LA thrombus in low risk patients identified by CHADS2VASC score regardless anticoagulation therapy prior to cardioversion or ablation.

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162 TRANSTHORACIC ECHOCARDIOGRAPHY PREDICTORS OF LEFT ATRIAL THROMBUS AND DENSE SMOKE IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION.:

Journal of Investigative Medicine ◽

10.2310/6650.2005.x0008.161 ◽

2006 ◽

Vol 54 (1) ◽

pp. S284.5-S285

Author(s):

A. Stoyioglou ◽

B. K. Ssennyamantono ◽

N. Marino ◽

R. Kutnick ◽

G. Panagopoulos ◽

...

Keyword(s):

Atrial Fibrillation ◽

Transthoracic Echocardiography ◽

Left Atrial ◽

Left Atrial Thrombus ◽

Nonvalvular Atrial Fibrillation ◽

Atrial Thrombus

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Prevalence and Resolution of Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation and Flutter With Oral Anticoagulation

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.09.027 ◽

2019 ◽

Vol 123 (1) ◽

pp. 63-68 ◽

Cited By ~ 15

Author(s):

Adam D. Niku ◽

Takahiro Shiota ◽

Robert J. Siegel ◽

Florian Rader

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Left Atrial ◽

Left Atrial Thrombus ◽

Nonvalvular Atrial Fibrillation ◽

Atrial Thrombus ◽

Atrial Fibrillation And Flutter

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Suspected intraoperative formation of left atrial thrombus in a patient with atrial fibrillation receiving bridging anticoagulation therapy

Journal of Anesthesia ◽

10.1007/s00540-013-1664-y ◽

2013 ◽

Vol 28 (1) ◽

pp. 112-115

Author(s):

Kohei Godai ◽

Maiko Hasegawa-Moriyama ◽

Kana Unoki ◽

Yoji Uchida ◽

Tamotsu Kuniyoshi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Anticoagulation Therapy ◽

Left Atrial Thrombus ◽

Atrial Thrombus ◽

Bridging Anticoagulation

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Association of CHADS2and CHA2DS2-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

BioMed Research International ◽

10.1155/2017/6839589 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

J. Huang ◽

SL. Wu ◽

YM. Xue ◽

HW. Fei ◽

QW. Lin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Area Under The Curve ◽

Predictive Ability ◽

Left Ventricular ◽

Left Atrial Thrombus ◽

Nonvalvular Atrial Fibrillation ◽

Atrial Thrombus

The main mechanism of the CHADS2and CHA2DS2-VASc scores to predict stroke in nonvalvular atrial fibrillation (NVAF) is still controversial. We evaluated the association of the CHADS2and CHA2DS2-VASc scores with left atrial thrombus (LAT) as detected by transesophageal echocardiographic (TEE) and compared the predictive ability of these risk stratification schemes with nonvalvular atrial fibrillation (NVAF). Data from 2,695 consecutive NVAF patients in whom TEE was performed for screening LAT from July 2007 to February 2014 were analyzed. Only 3% of the subjects had LAT. Presence of LAT was not significantly associated with either CHADS2 (P=0.07)or CHA2DS2-VASc score(P=0.12). The area under the curve (AUC) concerning LAT prediction using CHADS2and CHA2DS2-VASc was 0.574 and 0.569, respectively. A composition model includes previous stroke or transient ischemic attack, nonparoxysmal AF, moderate to severe left ventricular systolic dysfunction, left atrial enlargement, and cardiomyopathy which improved the discrimination significantly (AUC = 0.743). In our cohort, both CHADS2and CHA2DS2-VASc scores were of limited value for predicting LAT in patients with NVAF. This questions the CHADS2/CHA2DS2-VASc score predicting stroke mainly through the mechanism of cardiogenic embolism. A scoring scheme combining clinical and echocardiographic parameters may better predict LAT as a surrogate for cardioembolic risk in NVAF patients.

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