Abstract 18114: Prevalence of Left Atrial Appendage Thrombus in Oncologic Patients with Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nada Memon ◽  
David F Briceno ◽  
Mehul R Bhalja ◽  
Jose Banchs
Keyword(s):  
Atrial Fibrillation ◽  
Cancer Patients ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Left Ventricular Ejection ◽  
Oncologic Patients ◽  
The Mean

Introduction: There is considerable evidence that the left atrial appendage (LAA) is a common site for thrombus formation and its characteristics pose varying risks for having embolic events. Furthermore, atrial fibrillation has been found to occur with an increased frequency in patients with malignancies. The lack of evidence of standardized treatment strategies in the cancer population forces physicians to take an individualized approach to atrial fibrillation and stroke prevention. Herein, we describe the LAA characteristics in a cancer population with atrial fibrillation. Hypothesis: Cancer patients have an increased risk of LAA thrombus formation in atrial fibrillation. Methods: This is a retrospective study to determine the prevalence of LAA thrombus in a cohort of oncologic patients with atrial fibrillation. Two hundred and forty-five patients underwent transesophageal echocardiogram (TEE) at MD Anderson Cancer Center during the period 2000-2013 for atrial fibrillation evaluation. Results: LAA thrombus was identified in 6.5% of patients (16 of 245). During follow up, three of these patients had experienced a stroke (19%). The mean age was 67 with 5 females (31%) and 11 males (69%). Fifteen patients were white. The majority of patients had solid tumors (75%, 12 of 16). The mean CHADS2 score was 1.3 +/- 0.9 and the mean left ventricular ejection fraction on transthoracic echo was 57 +/- 9%. Spontaneous echo contrast was noted on TEE in 56% of patients (9 of 16). Five patients were on antiplatelet therapy and 9 were on oral anticoagulants. Oncologic, TEE, and clinical data are detailed below (Table 1). Conclusions: The prevalence of LAA thrombus and stroke in cancer patients with atrial fibrillation is significant. These findings may be a reflection of the enhanced inflammatory state of cancer. This data suggest that LAA thrombus evaluation is critical in determining the anticoagulation strategy in atrial fibrillation patients with cancer.

scholarly journals The profile of patients with atrial fibrillation scheduled for cardioversion or catheter ablation hospitalized in a Romanian rehabilitation hospital

2021 ◽  
pp. 306-313
Author(s):  
Sorin Nicolae BLAGA ◽  
Nicolae TODOR ◽  
Dumitru ZDRENGHEA ◽  
Radu ROȘU ◽  
Gabriel CISMARU ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Left Ventricular Ejection ◽  
Anticoagulant Treatment ◽  
Oral Anticoagulant Treatment ◽  
Inflammatory Status

Objectives - Structural cardiac, mainly atrial remodeling in non-valvular atrial fibrillation (NVAF) creates conditions for thromboembolic complications, despite the optimization of oral anticoagulant treatment over the past years. This study aims to provide a comparative analysis of patients with NVAF, with and without atrial thrombotic masses, in an integrated approach using clinical, electrocardiographic, anatomohemodynamic cardiac findings assessed by echocardiography, as well as an evaluation of the inflammatory status based on the usual screening blood markers. Methods – The study was based on the anonymous analysis of the medical records of 50 patients with NVAF monitored in a center of cardiology in Cluj-Napoca between March 2019 – February 2020, who received optimal oral anticoagulant treatment, all undergoing transesophageal ultrasound prior to cardioversion or ablation therapy. The statistical data processing methods were based on the “chi square” test and overall model fit logistic regression. Results – Atrial thrombotic complications were found in 7 (14%) patients with NVAF. These had, compared to patients without thrombotic masses, a mean CHA2DS2-VASc scale of 3 versus 2.76 (p=0.05), more frequently other atrial tachyarrhythmias (p<0.01), a more expressed inflammatory reaction (p=0.02), as well as a reduction of LVEF (p<0.01) and the peak left atrial appendage emptying velocity (p<0.01). Conclusions – In addition to a high CHA2DS2-VASc score, left anatomohemodynamic cardiac alteration, atrial arrhythmic complexity and background inflammatory status create conditions for high thromboembolic risk in patients with NVAF. Keywords: non-valvular atrial fibrillation, cardiac thrombosis, left ventricular ejection fraction, inflammatory status, peak left atrial appendage velocity,

P3774Prediction of left atrial appendage thrombosis in nonvalvular atrial fibrillation by means of predictors not related to CHA2DS2-VASc score

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Gizatulina ◽  
N Y Khorkova ◽  
A V Belokurova ◽  
V E Kharats ◽  
L U Martyanova
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Left Ventricular Ejection ◽  
Nonvalvular Atrial Fibrillation ◽  
Eccentric Hypertrophy ◽  
Cardiac Geometry

Abstract Background Nonvalvular atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia and the most frequent cause of cardio-embolic stroke. It is well known that left atrial appendage thrombi (LAAT) are the source of most embolic strokes in patients with AF, and can be easily identified by transesophageal echocardiography (TEE). Purpose To determine additional LAAT predictors not included in the CHA2DS2-VASc score in patients with nonvalvular AF. Methods Retrospective study enrolled 636 patients with nonvalvular AF (400 males) aged 24–84 years (mean age 57.8±9.1), admitted to our Research Center in 2014–2017 for catheter ablation or electrical cardioversion. All patients had scheduled transthoracic echocardiography (TTE), as well as TEE performed to exclude LAAT. Four forms of cardiac geometry were revealed with the help of TTE according to Recommendations of ASE and EACI: normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. Results According to TEE results, LAAT (6.6%) was detected in 42 patients from 636. Patients with LAAT more often had persistent and permanent AF (assigned as “AF stability”), had bigger sizes and volumes of left and right cardiac chambers, lower left ventricular ejection fraction, more expressed LV hypertrophy and lower blood flow velocity in the LA appendage compared to patients without LAAT. Remodeling types also varied: less LAAT patients had normal cardiac geometry and more LAAT patients had LV eccentric hypertrophy. To analyze factors associated with AF, we used a multivariable logistic regression model, involving the potential independent, clinically relevant variables and echocardiographic parameters. Logistic regression analysis identified the latter three as independent predictors for LAAT (Table 1). According to ROC-analysis the quality of the received model was assessed as good: AUC=0.763 (p<0.01), sensitivity – 75.8%, specificity – 72.2%. Table 1 Predictors B Wald statistics χ2 P OR 95% CI AF stability 0.913 4.143 0.042 2.491 1.034–6.000 LA diameter, mm 0.149 8.684 0.003 1.160 1.051–1.281 Eccentric hypertrophy 1.440 7.411 0.006 4.222 1.497–11.908 Constant −10.613 24.088 0.000 Conclusion From risk factors, not included in the CHA2DS2-VASc score, in addition to such predictable values as AF stability and left atrial diameter, such predictor as eccentric left ventricular hypertrophy was revealed, which in our study was associated with more than a 4-fold increase in the risk of LAAT.

scholarly journals Left atrial appendage thrombosis in a patient with Friedreich Ataxia–related cardiomyopathy, left ventricular systolic dysfunction, and atrial fibrillation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110564
Author(s):  
Michele Russo ◽  
Annachiara Nuzzo ◽  
Matteo Foschi ◽  
Simona Boarin ◽  
Stefano Lorenzetti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Friedreich Ataxia ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Friedreich ataxia is the most common form of hereditary ataxia. Heart involvement in Friedreich ataxia is common and can include increased left ventricular wall thickness, atrial fibrillation, and in the later stages, a reduction of left ventricular ejection fraction. We present the case of a 45-year-old man with a history of paroxysmal atrial fibrillation and a congestive heart failure, hypertension, age ⩾ 75 years, diabetes mellitus, stroke, vascular disease, age 65–74 years, and female sex (CHA2DS2-VASc) score of only 1 (because of reduced left ventricular ejection fraction) who presented with pneumonia and was also found to have atrial fibrillation with a rapid ventricular response. Despite already being on long-term therapy with a non-vitamin K-antagonist oral anticoagulant, a transesophageal echocardiogram showed a mobile floating thrombus in the left atrial appendage. In accordance with previous necropsy evidence of thrombosis and thromboembolism in Friedreich ataxia subjects who likely have had only non-sex-related CHA2DS2-VASc score ⩽1, this case suggests that the risk of thromboembolism in Friedreich ataxia subjects with atrial fibrillation may not be adequately predicted by the sole CHA2DS2-VASc score.

scholarly journals Left Ventricular Ejection Fraction Is Associated with the Risk of Thrombus in the Left Atrial Appendage in Patients with Atrial Fibrillation

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Beata Uziębło-Życzkowska ◽  
Paweł Krzesiński ◽  
Agnieszka Jurek ◽  
Agnieszka Kapłon-Cieślicka ◽  
Iwona Gorczyca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Introduction. Atrial fibrillation (AF) is associated with high risk of ischemic stroke. The most frequent thrombus location in AF is the left atrial appendage (LAA). Transthoracic echocardiography (TTE) is a basic diagnostic examination in patients (pts) with AF. Objectives. To analyse the relations between basic echocardiographic features, well-established stroke risk factors, type of AF, and anticoagulation therapy with the incidence of left atrial appendage thrombus (LAAT). Patients and Methods. The study group consisted of 768 pts with AF (mean age, 63 years), admitted to three high-reference cardiology departments. Five hundred and twenty-three pts were treated with non-vitamin K antagonist oral anticoagulants (NOACs) and 227 (30%) with vitamin K antagonists (VKAs). The subjects underwent TTE and transesophageal echocardiography (TEE) before cardioversion or ablation. Results. LAAT was significantly more frequent in pts with reduced left ventricular ejection fraction (LVEF): in 10.6% (7 pts) with LVEF<40% and in 9.0% (9 pts) with LVEF 40-49%, while only in 5.5% (33 pts) with LVEF>50%. Compared to pts without LAAT, those with LAAT presented with lower LVEF and higher left atrial diameter (LAD). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: previous bleeding, treatment with VKA, and LVEF. Conclusion. LAAT is related to lower LVEF and higher LAD. LVEF is one of the independent predictors of LAAT. Even in the case of adequate anticoagulant therapy, it might be prudent to consider TEE before cardioversion or ablation in patients with low LVEF and LA enlargement, especially in the coexistence of other thromboembolic risk factors.

A Morphological Study of Left Atrial Appendage in Egyptian patients Using multidetector computed tomography (MDCT)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Mohamed Hassan ◽  
Hazem Mohamed Abdel Menaem ◽  
Ahmed Mohamed Onsy ◽  
Azza Alaa Omran ◽  
Mona Mostafa Mohamed Rayan
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Multidetector Computed Tomography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Egyptian Patients

Abstract Background The most common etiology of stroke is known to be cardio- embolic type and left atrial appendage is the site of origin of thrombi in 90% of cardio embolic stroke .Most literature reports that left atrial appendage thrombi tend to be more common in females and black people1. In the past, the left atrial appendage (LAA) has been considered to be a relatively insignificant portion of cardiac anatomy. It is now recognized that it is a structure with important pathological associations as thrombus has a predilection to form within the LAA in patients with non-valvar atrial fibrillation and to a lesser extent in those with mitral valve disease (both in atrial fibrillation and in sinus rhythm). The exact pathogenesis of thrombus formation inside left atrial appendage is still not fully elucidated, but many literature suppose that the cause is the stagnation within the long, blind-ended trabeculaed pouch2 Objective to describe left atrial appendage morphology and identify the prevalence of its different subtypes in Egyptian patients. Material and Methods the study analyzed retrospectively the data of 100 consecutive Egyptian patients who underwent multidetector computed tomography (MDCT) at Ain shams university specialized hospital from August 2019 to February 2020.Axial source images, two and threedimensional data sets were evaluated for each of the patients .All images were analyzed by a qualified cardiologist using dedicated software called “Horos Workstation”, and were blinded to patient data. All images were assessed and evaluated for LAA morphology and volume and were categorized according to the classification of Wang et al. 2010. Results windsock morphology existed in 32% of patients followed by chicken wing in 25% of patients. Cauliflower morphology was reported in 23% of patients whereas 20% of patients had cactus morphology. There was significant gender difference in LAA morphology where female patients had more cauliflower and cactus morphology as compared to male gender (p &lt; 0.05). Left atrial appendage volume showed a statistically significant positive correlation with advanced age and significant negative correlation with Left ventricular ejection fraction. Conclusion Egyptian patients had predominantly windsock morphology in males and cactus morphology in females.

scholarly journals Large extracellular vesicles in the left atrial appendage in patients with atrial fibrillation—the missing link?

2021 ◽  
Author(s):  
Andreas Zietzer ◽  
Baravan Al-Kassou ◽  
Paul Jamme ◽  
Verena Rolfes ◽  
Eva Steffen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Extracellular Vesicles ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Flow Cytometric Analysis ◽  
Heart Rhythm ◽  
Atrial Appendage ◽  
Peripheral Embolization

AbstractAtrial fibrillation (AF) is the most frequent arrhythmic disease in humans, which leads to thrombus formation in the left atrial appendage and stroke through peripheral embolization. Depending on their origin, large extracellular vesicles (lEVs) can exert pro-coagulant functions. In the present study, we investigated how different types of AF influence the levels of large EV subtypes in three distinct atrial localizations. Blood samples were collected from the right and left atrium and the left atrial appendage of 58 patients. 49% of the patients had permanent AF, 34% had non-permanent AF, and 17% had no history of AF. Flow cytometric analysis of the origin of the lEVs showed that the proportion of platelet-derived lEVs in the left atrial appendage was significantly higher in permanent AF patients compared to non-permanent AF. When we grouped patients according to their current heart rhythm, we also detected significantly higher levels of platelet-derived lEVs in the left atrial appendage (LAA) in patients with atrial fibrillation. In vitro studies revealed, that platelet activation with lipopolysaccharide (LPS) leads to higher levels of miR-222-3p and miR-223-3p in platelet-derived lEVs. Treatment with lEVs from LPS- or thrombin-activated platelets reduces the migration of endothelial cells in vitro. These results suggest that permanent atrial fibrillation is associated with increased levels of platelet-derived lEVs in the LAA, which are potentially involved in LAA thrombus formation.

scholarly journals Incidence and predictors of left atrial thrombus development in patients scheduled for repeat catheter ablation for atrial fibrillation: Is transesophageal echocardiography always mandatory?

2021 ◽  
Author(s):  
Satoshi Yanagisawa ◽  
Yasuya Inden ◽  
Shuro Riku ◽  
Kazumasa Suga ◽  
Koichi Furui ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Imaging Modality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Imaging Evaluation ◽  
Ventricular Ejection Fraction

Introduction: The risk of developing left atrial (LA) thrombi after initial catheter ablation for atrial fibrillation (AF) and requirements for imaging evaluation for thrombi screening at repeat ablation is unclear. This study aimed to assess the occurrence of thrombus development and frequency of any imaging study evaluating thrombus formation during repeat ablation for AF. Methods: Of 2,066 patients undergoing initial catheter ablation for AF with uninterrupted oral anticoagulation, 615 patients underwent repeat ablation after 258.0 (105.0-882.0) days. We investigated which factors were associated with safety outcomes and requirements for thrombi screening. Results: All patients underwent at least one imaging examination to screen for thrombi in the first session, but the examination rate decreased to 476 patients (77%) before the repeat procedure. The frequency of imaging evaluations was 5.0%, 11%, 21%, 84%, and 91% for transesophageal echocardiography and 18%, 33%, 49%, 98%, and 99% for any imaging modality at repeat ablation performed ≤60 days, ≤90 days, ≤180 days, >180 days, and >1 year after the initial procedure, respectively. Three patients (0.5%) developed LA thrombi at repeat ablation due to identifiable causes, and no patients had thromboembolic events when no imaging evaluation was performed. Multivariate analysis revealed that repeat ablation >180 days, non-paroxysmal atrial arrhythmias, and lower left ventricular ejection fraction were predictors of the risk of thrombus development. Conclusions: The risk development of thrombus at repeat ablation for AF was low. There needs to be a risk stratification for the requirement of imaging screening for thrombi at repeat ablation for AF.

scholarly journals Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lei Chen ◽  
Changjiang Xu ◽  
Wensu Chen ◽  
Chaoqun Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Flow Velocity ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Linear Regression Analysis ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Mechanical Function ◽  
Orifice Area ◽  
The Relationship

Abstract Background Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed. Results The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = −  0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV. Conclusions The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.

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