scholarly journals DETECTION OF LEFT ATRIAL APPENDAGE THROMBUS IN SETTING OF ATRIAL FIBRILLATION OR ATRIAL FLUTTER WITH CONTRAST TRANSESOPHAGEAL ECHOCARDIOGRAPHY

2012 ◽  
Vol 59 (13) ◽  
pp. E1272
Author(s):  
Arvin Bansal ◽  
Ali Mithani ◽  
Chad Travers ◽  
Steven Feinstein
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Thrombus

scholarly journals Inverse Correlation Between Left Atrial Appendage Function and CHA2DS2-VASc Score in Patients with Atrial Flutter

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Mei-Yao Wu ◽  
Yen-Nien Lin ◽  
Hung-Pin Wu ◽  
Ying-Ying Huang ◽  
Jan-Yow Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Transesophageal Echocardiography ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Inverse Correlation ◽  
Atrial Appendage ◽  
Inclusion Criteria

AbstractImpaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA2DS2-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n = 38) and AFL with paroxysmal AF (PAF) (n = 19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9 cm/s vs. 51.5 cm/s, P = 0.004) and LAA-EF (28.4% vs. 36.5%, P = 0.024) measured during AFL were significantly lower in the AFL + PAF group than in the isolated AFL group. Significant inverse correlations between the CHA2DS2-VASc score and LAA-EF were identified in the AFL (P = 0.008) and AFL + PAF (P = 0.032) groups. We observed progressive LAA dysfunction in patients with AFL + PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHA2DS2-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.

A Stunning Left Atrial Appendage Thrombus

Cardiology ◽  
2016 ◽  
Vol 134 (4) ◽  
pp. 394-397
Author(s):  
Sajid Ali ◽  
Justin Ugwu ◽  
Yousuf Kanjwal
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Flutter ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Atrial Appendage ◽  
Transesophageal Echocardiogram ◽  
Left Atrial Appendage Thrombus

Background: Left atrial appendage thrombus formation is a known major complication of atrial fibrillation and atrial flutter which increases the risk of embolism and stroke. This risk of thrombosis is greatly increased with a lack of anticoagulation. After conversion to a normal sinus rhythm in these arrhythmias, the risk of thrombus formation in the left atrium persists through a phenomenon termed atrial myocardial stunning. Case: We present the case of a patient who previously underwent successful pulmonary vein isolation and was found to be in typical isthmus-dependent atrial flutter with a questionable recurrence of atrial fibrillation. The decision was made to return for atrial flutter ablation and for evaluation of prior pulmonary vein isolation. Initially, a transesophageal echocardiogram showed a normal ejection fraction, biatrial enlargement and no left atrial appendage thrombus. Ablation of the cavotricuspid isthmus was successfully accomplished with documented bidirectional block. A transesophageal echocardiogram probe was still in place prior to planned transseptal puncture for the evaluation of pulmonary veins. A large thrombus was now observed filling the left atrial appendage. Conclusion and Objective: Atrial stunning is a transient atrial contractile dysfunction that occurs whether sinus rhythm is restored spontaneously, electrically, pharmacologically or by ablation. We know after conversion that there is higher propensity to increased spontaneous echogenic contrast and decreased velocities; however, we do not have documented knowledge of exactly how soon after the conversion to a sinus rhythm a thrombus may be seen. We demonstrate a case of acute left atrial appendage thrombus formation immediately following the successful ablation of isthmus-dependent atrial flutter. Our report validates the belief that strategies of not interrupting anticoagulation prior to the conversion of these arrhythmias should be implemented.

scholarly journals Endoscopic Ultrasound for the Detection of Left Atrial Appendage Thrombus: A Useful Technique in Patients with Transesophageal Echocardiography Contraindication

2016 ◽  
Vol 2016 ◽  
pp. 1-2
Author(s):  
Manuel Marina-Breysse ◽  
Alfonso Jurado-Román ◽  
Bartolomé López-Viedma ◽  
Jesús Piqueras-Flores ◽  
María T. López-Lluva
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Endoscopic Ultrasound ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Thrombus ◽  
Therapeutic Technique ◽  
Esophageal Bleeding ◽  
Rule Out

Endoscopic ultrasound is a diagnostic and therapeutic technique used in specialized centers for patients that have undergone digestive procedures. This technique enables highly precise real-time imaging of the digestive tract wall and surrounding organs. Endoscopic ultrasound is also useful in patients with cardiovascular diseases such as atrial fibrillation. In patients with contraindication for transesophageal echocardiography due to high risk of esophageal bleeding or complications that may require immediate intervention, endoscopic ultrasound may be a safer option for visualizing atrial chambers to rule out the presence of left atrial appendage thrombi before cardioversion.

scholarly journals Intracardiac Versus Transesophageal Echocardiography for diagnosis of Left Atrial Appendage Thrombosis in Atrial Fibrillation: a Meta-analysis

2021 ◽  
Author(s):  
Guijun He ◽  
Hanxion Liu ◽  
Xiaoyu Huang ◽  
Xiaoqi Deng ◽  
Guosu Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Meta Analysis ◽  
Atrial Appendage ◽  
Cochrane Library ◽  
Left Atrial Appendage Thrombus ◽  
Suitable Alternative ◽  
Significant Difference

Abstract Introduction: Left atrial appendage (LAA) thrombus in patients with atrial fibrillation is usually detected by transesophageal echocardiography (TEE). Intracardiac echocardiography (ICE) can be a suitable alternative to detect thrombosis. We performed a meta-analysis of all studies that compared ICE vs. TEE for LAA thrombosis.Methods: We searched PubMed, Cochrane Library, and Embase for published abstracts and manuscripts until June 1, 2020. Studies reporting clinical outcomes comparing TEE vs. ICE for LAA thrombus in human subjects aged ≥ 18 years were included. Two investigators independently extracted the data and an individual quality assessment was performed. The analysis was performed using RevMan 5.3, STATA 15, and Meta-Disc 1.4.Results: Eight eligible studies consisting of 1108 patients (TEE = 558 vs. ICE = 550) were included. The average sensitivity of ICE and TEE to diagnose left atrial appendage thrombus was 1.0 (95% CI: 0.91-1.00) vs 0.68 (95% CI: 0.49-0.83),and specificity of ICE and TEE to diagnosis of left atrial appendage thrombus was 1.0 (95% CI: 0.99-1.00) vs 0.98 (95% CI: 0.96-0.99) . The AUC of ICE and TEE were 0.9846 (SEAUC = 0.0196) and 0.9655 (SEAUC = 0.0401), and the Q * statistics were 0.9462 (SEQ * = 0.0406) and 0.9127 (SEQ * = 0.0616), respectively. Z test was performed on Q * statistics (Z = 0.45, P> 0.05), there was no significant difference between ICE and TEE.Conclusion: ICE and TEE have similar diagnostic efficacy for left atrial appendage thrombosis, but ICE has higher sensitivity and specificity, which has certain advantages over TEE and has clinical application prospects.

scholarly journals Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography

Medicine ◽  
2018 ◽  
Vol 97 (26) ◽  
pp. e11117 ◽  
Author(s):  
Xiao Fei Xing ◽  
Nan Nan Liu ◽  
Ya Ling Han ◽  
Wei Wei Zhou ◽  
Ming Liang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Dabigatran Etexilate ◽  
Atrial Appendage ◽  
Left Atrial Appendage Thrombus

PREDICTING VALUE OF LEFT ATRIAL APPENDAGE THROMBUS IN NONVALVULAR ATRIAL FIBRILLATION PATIENTS BY CHADS2 AND CHADS2-VAS’SCORE AND BY TRANSTHORACIC ECHOCARDIOGRAPHIC PARAMETERS

2012 ◽  
pp. 36-42
Author(s):  
Thuc Quang Bui ◽  
Dien Bien Vu ◽  
Nguyen Son Pham
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Key Words ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Nonvalvular Atrial Fibrillation ◽  
Left Atrial Appendage Thrombus ◽  
Echocardiographic Parameters ◽  
And Function

Objectives: To evaluate size and function of left atrium and left atrial appendage (LAA) by using transthoracic and transesophageal echocardiography in nonvalvular atrial fibrillation (NVAF) patients. Method: 127 NVAF patients (mean age 65,8 ± 10,0 years) were assessed by using CHADS2 and CHADS2-VAS score, transthoracic and transesophageal echocardiographic parameters. Results: CHADS2 ≥3, CHADS2-VAS ≥ 4 and LAVI ≥ 38ml/m2, diagnosis of LAA thrombus has been expected in turn with Se=67% and Sp=70%, Se=67% and Sp=71% and Se=80% and Sp=60%; With LEVF/LAVI ≤1,5, risk of LAA thrombus was OR=13,3; 95% CI (1,8 – 98,5) with p=0,001. Conclusion: CHADS2, CHADS2-VAS, LAVI and ratio LVEF/LAVI are predictors of LAA thrombus in NVAF patients. Key words: CHADS 2, CHADS 2 -VAS, left atrial appendage thrombus, thromboembolism, nonvalvular atrial fibrillation

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