Relationship Between Left Atrial Appendage Function and Left Atrial Thrombus in Patients With Nonvalvular Chronic Atrial Fibrillation and Atrial Flutter

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.

Download Full-text

A Stunning Left Atrial Appendage Thrombus

Cardiology ◽

10.1159/000444166 ◽

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.

Download Full-text

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

Download Full-text

Effect of Inotropic Stimulation on Left Atrial Appendage Function in Atrial Myopathy of Chronic Atrial Fibrillation

Echocardiography ◽

10.1111/j.1540-8175.2000.tb01142.x ◽

2000 ◽

Vol 17 (4) ◽

pp. 313-318 ◽

Cited By ~ 10

Author(s):

MASOOR KAMALESH ◽

T. BURTON COPELAND ◽

STEPHEN SAWADA

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Chronic Atrial Fibrillation ◽

Atrial Appendage ◽

Inotropic Stimulation

Download Full-text

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)

Download Full-text

Left Atrial Appendage Resection Can Reduce Thrombotic Risk of Chronic Atrial Fibrillation

Journal of Arrhythmia ◽

10.4020/jhrs.27.pe4_013 ◽

2011 ◽

Vol 27 (Supplement) ◽

pp. PE4_013

Author(s):

Toshiya Ohtsuka ◽

Mikio Ninomiya ◽

Takahiro Nonaka ◽

Motoyuki Hisagi

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Chronic Atrial Fibrillation ◽

Atrial Appendage ◽

Thrombotic Risk

Download Full-text

Key Role of Left Atrial Appendage during Redo Ablation in a Case of Long-Standing Persistent Atrial Fibrillation

Case Reports in Cardiology ◽

10.1155/2020/9691584 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Shaohui Wu ◽

Guangchen Zou ◽

Xu Liu ◽

Weifeng Jiang ◽

Mu Qin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Left Atrial ◽

Left Atrial Appendage ◽

Persistent Atrial Fibrillation ◽

The Other ◽

Atrial Appendage ◽

Electrical Isolation ◽

Rare Phenomenon

Extrapulmonary vein focal sources have been recognized as the source of atrial fibrillation in some cases, and empiric electric isolation of the left atrial appendage has been proposed for long-standing persistent atrial fibrillation by some. Here, we present a case of redo ablation of long-standing persistent atrial fibrillation in which the left atrial appendage played a key role in maintaining AF during ablation, and atrial fibrillation was terminated by electrical isolation of the LAA. During the ablation, a rare phenomenon of half of the atria in atrial fibrillation while the other half of the atria in atrial flutter was seen.

Download Full-text