Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation

IntroductionWe aimed to compare the prevalence of left atrial appendage (LAA) thrombus and its predictors between old and young patients with atrial fibrillation (AF).Material and methodsThe study included 1970 patients aged ≥ 65 (n = 822 [41.7%]) and < 65 (n = 1148 [58.3%]) referred for AF cardioversion or ablation preceded by transoesophageal echocardiography (TEE).ResultsOral anticoagulation (OAC) was prescribed in 799 (97.2%) patients aged ≥ 65 years and in 1054 (91.8%) of those aged < 65 years (p < 0.001). In patients treated with OAC, those aged ≥ 65 years less often received vitamin K antagonist (VKA) (267 [33.4%] vs. 416 [39.5%]) and more often non-VKA-OAC (NOAC) (532 [66.6%] vs. 638 [60.5%], p = 0.008, p = 0.008) compared to patients < 65 years. On TEE, LAA thrombus was more often observed in patients aged ≥ 65 years than those aged < 65 years (63 [7.7%] vs. 46 [4.0%], p < 0.001), with an absolute but not statistically significant difference between patients aged 65–74 and ≥ 75 years (47 [7.3%] vs. 16 [8.8%], p = 0.528). In patients aged ≥ 65 years, there was no difference in the prevalence of LAA thrombus between patients treated with VKA and NOAC, in contrast to patients aged < 65 years, in whom such a difference was observed (27 [6.5%] vs. 16 [2.5%], p = 0.002). In multivariate logistic regression, predictors of LAA thrombus in both age groups were older age, non-paroxysmal AF, and heart failure, whereas only in patients aged < 65 years – VKA use, and in those aged ≥ 65 years – lower glomerular filtration rate and platelet count.ConclusionsDespite OAC use, older patients with AF remain at high risk of LAA thrombus formation. Older age, non-paroxysmal AF, and heart failure are predictors of LAA thrombus, irrespective of age.

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Left Atrial Appendage Thrombus Detected During Hyperacute Stroke Imaging Is Associated With Atrial Fibrillation

Stroke ◽

10.1161/strokeaha.120.030258 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3760-3764

Author(s):

Sajith C. Senadeera ◽

David G. Palmer ◽

Ross Keenan ◽

James Beharry ◽

Jen Yuh Lim ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Multivariable Logistic Regression Analysis ◽

Vessel Occlusion ◽

Imaging Protocol ◽

Hyperacute Stroke ◽

Stroke Imaging

Background and Purpose: Left atrial appendage (LAA) is the likely embolic source in atrial fibrillation (AF)–related cardioembolic strokes. We sought to determine the prevalence of LAA thrombus on hyperacute stroke imaging and its association with AF. Methods: We retrospectively examined the clinical and radiological features of patients assessed through the hyperacute stroke imaging pathway over a 12-month period at Christchurch Hospital. The LAA was included in the computed tomography angiogram scan-range as part of the multimodal imaging protocol. Two radiological readers blinded to clinical information independently assessed for the presence of LAA thrombus. The association between AF and LAA thrombus was determined by multivariable logistic regression analysis. Results: Of 303 patients included in the analysis, the overall prevalence of LAA thrombus was 6.6% and 14.9% in patients with known AF. Patients with LAA thrombus were older (85 versus 75 years, P <0.01), more commonly had known or newly diagnosed AF (75% versus 30%, P <0.01) and heart failure (30% versus 8%, P =0.01), and was associated with intracranial large vessel occlusion (65% versus 39%, P =0.02). In the multivariable model, AF (odds ratio, 3.71 [95% CI, 1.25–11.01] P =0.02) was independently associated with LAA thrombus after adjusting for age and congestive heart failure. Interrater reliability was moderate (kappa=0.56). Conclusions: LAA thrombus is a potential radiological marker of AF and can be assessed as a part of hyperacute stroke imaging.

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Game changer? A sporting indication to implant a left atrial appendage closure device in a rugby player with atrial fibrillation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz242 ◽

2020 ◽

Vol 4 (1) ◽

pp. 1-5

Author(s):

Andre Briosa e Gala ◽

Andrew Cox ◽

Michael Pope ◽

Timothy Betts

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Left Ventricular ◽

Atrial Appendage ◽

Rugby Player ◽

Management Options ◽

Left Atrial Appendage Occlusion ◽

Occlusion Device

Abstract Background Caring for athletes with cardiac disease requires an approach that caters to the specific needs of the athlete. Case summary A 27-year-old professional rugby player was admitted with decompensated heart failure and atrial fibrillation (AF). Transthoracic echocardiogram showed features in keeping with a dilated cardiomyopathy with severe left ventricular (LV) systolic impairment. He made good progress on evidence-based heart failure medication and his LV systolic function returned to normal. He failed to maintain sinus rhythm with cardioversion and remained in persistent AF. He then suffered a transient ischaemic attack despite appropriate anticoagulation. At 1-year follow-up, he was asymptomatic and against medical advice continued to play competitive rugby whilst taking rivaroxaban. He subsequently underwent implantation with a percutaneous left atrial appendage occlusion device, allowing him to discontinue anticoagulation, reduce his bleeding risk and resume his career, whilst simultaneously lowering the thromboembolic risk. Discussion Counselling should include different management options aimed at minimizing the risks to athletes if they to return to competitive sports. Left atrial appendage occlusion devices are a suitable AF-related stroke prevention strategy in athletes competing in full-contact sports.

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Patients undergoing prophylactic left atrial appendage ligation remain at risk for developing left atrial thrombus

Heart Rhythm ◽

10.1016/j.hrthm.2005.02.293 ◽

2005 ◽

Vol 2 (5) ◽

pp. S94

Author(s):

Soufian Almahameed ◽

David O. Martin ◽

Nassir F. Marrouche ◽

A. Marc Gillinov ◽

Andrea Natale

Keyword(s):

At Risk ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Left Atrial Thrombus ◽

Atrial Thrombus

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COMPARISION OF TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DETECTION OF LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL VALVULAR DISEASE

Journal of Nepal Medical Association ◽

10.31729/jnma.553 ◽

2004 ◽

Vol 43 (154) ◽

Author(s):

Deewakar Sharma ◽

A Maskey ◽

B M KC ◽

S Rajbhandary ◽

R Rajbhandary ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Transthoracic Echocardiography ◽

Left Atrial ◽

Left Atrial Appendage ◽

Valvular Disease ◽

Atrial Appendage ◽

Left Atrial Thrombus ◽

Routine Procedure ◽

Atrial Thrombus

Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvulardisease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients,LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them.Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAAthrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. Weconclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEEshould be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular diseaseprior to any surgical intervention.Key Words: Left atrial appendage (LAA), Transthoracic echocardiography (TTE),Transesophageal echocardiography (TEE)

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