scholarly journals Nomogram to Predict Left Atrial Thrombus or Spontaneous Echo Contrast in Patients With Non-valvular Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhitong Li ◽  
Quanbo Liu ◽  
Fei Liu ◽  
Tesfaldet H. Hidru ◽  
Yuqi Tang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Individual Risk ◽  
Good Prediction ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Ventricular Ejection Fraction ◽  
Spontaneous Echo Contrast

Background: The predictive power of the CHADS2 and CHA2DS2-VASc scores for the presence of Left atrial thrombus (LAT)/ spontaneous echo contrast (SEC) in non-valvular atrial fibrillation (NVAF) is modest. The aim of this analysis is to define clinical and ultrasonic variables associated with LAT/SEC and to propose nomograms for individual risk prediction.Methods: Data on 1,813 consecutive NVAF patients who underwent transesophageal echocardiography (TEE) from January 2016 to January 2021 were collected. The univariate and multivariate logistic regression analyses were used to construct a nomogram. We examined the predictive ability of the risk scores by calculating the area under the curve (AUC). Moreover, the performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness.Results: LAT/SEC was found in 260 (21.0%) and 124 (21.6%) patients in the training and validation cohorts, respectively. On multivariate analysis, independent factors for LAT/SEC were Age, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), hypertension (HTN), previous stroke or transient ischemic attack, Non-paroxysmal AF and a nomogram was built based on these variables. The calibration curve for the probability of LAT/SEC showed good prediction agreement with actual observation. The nomogram achieved good concordance indexes of 0.836 and 0.794 in predicting LAT/SEC in the training and validation cohorts, respectively. Decision curve analysis demonstrated that the nomogram would be clinically useful.Conclusions: In this study, a nomogram was constructed that incorporated six characteristics of NVAF patients. The nomogram may be of great value for the prediction of LAT/SEC in NVAF patients.

Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Non-Anticoagulated Nonvalvular Atrial Fibrillation Patients

Cardiology ◽  
2018 ◽  
Vol 140 (2) ◽  
pp. 87-95 ◽  
Author(s):  
Jun Huang ◽  
Hong-tao Liao ◽  
Hong-wen Fei ◽  
Yu-mei Xue ◽  
Li Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Scoring System ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Thrombus ◽  
Nonvalvular Atrial Fibrillation ◽  
Atrial Thrombus ◽  
Ventricular Ejection Fraction ◽  
New Scoring

Objectives: The aim of the study was to examine the association of CHADS2/CHA2DS2-VASc scores with left atrial thrombus (LAT) and spontaneous echocardiographic contrast (SEC) in non-anticoagulated nonvalvular atrial fibrillation (NVAF) spontaneous patients, and to develop a new scoring system for LAT/SEC prediction. Methods: Consecutive non-anticoagulated NVAF patients with or without LAT/SEC by transesophageal echocardiography were identified in the Guangdong General Hospital. Results: Among 2,173 patients, the prevalence of LAT/SEC was 4.9%. Both predictive values of CHADS2 and CHA2DS2-VASc scores for the presence of LAT/SEC were low-to-moderate (receiver operating characteristic [ROC] = 0.591 and 0.608, respectively, p = 0.90). By multivariate analysis, non-paroxysmal AF, decreased left ventricular ejection fraction, and left atrial enlargement were positively associated with LAT/SEC, while CHADS2/CHA2DS2VASc scores were not. A new scoring system based on these 3 factors above significantly improved the discrimination for LAT/SEC (ROC = 0.792). Conclusions: CHADS2/CHA2DS2-VASc scores had limited value in predicting LAT/SEC; a new scoring system that combines AF type and echocardiographic parameters may better predict LAT/SEC as a surrogate for cardioembolic risk in NVAF patients.

scholarly journals Safety of catheter ablation of AF without pre- or periprocedural imaging for the detection of LA thrombus

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
K Vlachos ◽  
G Bazoukis ◽  
E Prappa ◽  
A Megarisiotou ◽  
S Dragasis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Ventricular Ejection Fraction ◽  
Funding Sources ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Background The need for pre- or peri-procedural imaging to rule out the presence of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation (AF) is unclear in the era of uninterrupted direct oral anticoagulant (DOAC) regimen. We sought to examine the safety of catheter ablation in appropriately selected patients with paroxysmal AF without performing screening for left atrial thrombus. Methods Consecutive patients planned for radiofrequency AF catheter ablation between January 2016 and June 2020 were enrolled, and prospectively studied. All subjects were receiving uninterrupted anticoagulation with DOACs for at least 4 weeks before the procedure. All subjects were in sinus rhythm the day of the procedure. The primary outcome of the study was ischemic stroke or transient ischemic attack (TIA) during at 30 days. Results A total of 451 patients (age 59.7 ± 10.2 years, 289 males) with paroxysmal AF were included in the study. The mean CHA2DS2-VASc score was 1.4 ± 1.2. The mean left ventricular ejection fraction and left atrial diameter were 60 ± 5% and 39.3 ± 4 mm, respectively. Regarding the anticoagulation regimen, apixaban was used in 197 (43.6%) patients, rivaroxaban in 148 (32.8%) patients, and dabigatran in 106 (23.5%) patients. None of the patients developed clinical ischemic stroke or TIA during the 30-day post-discharged period. Conclusions Catheter ablation can be safely performed in low-risk patients with paroxysmal AF without imaging for the detection of left atrial thrombus in the era of uninterrupted DOAC anticoagulation.

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 HOLTER MONITORING AND ECHOCARDIOGRAPHY FOR PREDICTING THE EFFECTIVENESS OF PULMONARY VIEN ISOLATION IN PATIENTS WITH PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION

2018 ◽  
Vol 7 (3) ◽  
pp. 12-23
Author(s):  
A. V. Tregubov ◽  
Yu. V. Shubik
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Atrial Size ◽  
Ventricular Ejection Fraction ◽  
Atrial Size ◽  
The Impact

Aim. To evaluate the impact of the atrial ectopic activity and left ventricular diastolic dysfunction on predicting the effectiveness of pulmonary vein isolation (PVI) in patients with paroxysmal and persistent atrial fibrillation (AF).Methods. 54 patients with paroxysmal and persistent AF and the normal left ventricular ejection fraction were included in the study. Patients underwent Holter monitoring and echocardiography prior to the intervention to identify the predictors of successful PVI. The follow-up was 12 months after the indexed procedure. The effectiveness of treatment was assessed from the third month of the postoperative period. The criterion of the successful treatment was the absence of the AF paroxysms lasting more than 30 seconds, confirmed by Holter, diurnal and / or multi-day monitoring. The Student's t-test was used to assess the reliability of the differences between the variables characterizing the treatment results in the study groups. The discriminant analysis was performed to develop an algorithm that allows predicting the PVI result. A p value <0.05 was considered statistically significant.Results. Premature atrial contraction over 70 per hour can be considered as the predictor of the successful PVI in patients with normal left atrial size. The severe LA enlargement should be considered as a predictor of poor ablation efficacy. The obtained discriminant function allows predicting the effectiveness of PVI in patients with paroxysmal and persistent AF depending on Holter monitoring and echocardiography. Its sensitivity is high for both predicting success and failure of the intervention.Conclusion. Holter monitoring and echocardiography allow predicting the effectiveness of PVI. The intervention's efficacy in the groups of patients with severe LA enlargement and the combination of normal left atrial size with over 70 PAC per hour should be addressed in the further studies.

P3764Morphological mechanisms of atrial functional mitral regurgitation in patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Nagaoka ◽  
Y Mukai ◽  
S Kawai ◽  
S Takase ◽  
K Sakamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Ventricular Ejection Fraction

Abstract Background Atrial functional mitral regurgitation (AFMR) occurs in patients with atrial fibrillation. However, morphological mechanisms of AFMR are poorly understood. Purpose The purpose of this study was to examine the morphological characteristics in patients with AFMR. Methods Among consecutive 795 patients undergoing initial radiofrequency catheter ablation (RFCA) at our hospital, twenty-five patients with persistent AF accompanied by AFMR (≥ moderate) before RFCA (AFMR group) were studied. Age-matched 25 patients with persistent AF without MR were defined as a control group. Results Left ventricular ejection fraction (LVEF) was lower and left atrium volume index was larger in the AFMR group (Table). Mitral valve annulus diameter and length of anterior mitral leaflet (AML) were similar between groups, whereas length of posterior mitral leaflet (PML) was significantly shorter in the AFMR group. Smaller tethering angle of AML (γ in the figure) and shorter tethering height were significantly associated with the occurrence of AFMR, which were different from morphology of functional mitral regurgitation in patients with dilated LV. Multiple regression analysis revealed that less tenting height (p<0.05) and LA dilatation toward the posterior (p<0.01) were significantly related to AFMR. Echocardiographic parameters AFMR (n=25) Control (n=25) P value Age, y 69±8 66±10 NS Male, n (%) 9 (36) 20 (80) P=0.001 LVEF,% 60±9 67±6 P=0.004 LAD, mm 44±5 41±7 NS LAVI, ml/m2 56±17 41±13 P<0.001 MV diameter, mm 3.9±0.4 3.8±0.5 NS α angle, ° 34±9 35±7 NS β angle, ° 48±9 50±8 NS γ angle, ° 32±5 37±5 P=0.0005 AML length, mm 3.0±0.5 3.0±0.5 NS PML length, mm 2.1±0.1 2.4±0.1 P=0.03 Tenting height, mm 1.5±0.1 1.8±0.1 P=0.02 D, mm 0.8±0.3 0.5±0.3 P=0.001 LVEF: left ventricular ejection fraction; LAD: left atrial diameter; LAVI: left atrial volume index; AML: anterior mitral leaflet; PML: posterior mitral leaftlet. Conclusions AFMR occurs in patients with unique morphological features, such as less tethering height and LA dilatation toward the posterior.

scholarly journals 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

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
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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