Key result
Non-paroxysmal AF is linked to ~212% higher risk of LAA thrombogenic milieu.
Why the study?
The study aimed to investigate the prevalence, predictors, and management of transesophageal echocardiography-identified left atrial appendage thrombogenic milieu in non-valvular atrial fibrillation patients with low to moderate thromboembolic risk.
What are the prevalence, predictors, and management outcomes of left atrial appendage thrombogenic milieu in non-valvular atrial fibrillation patients with low to moderate thromboembolic risk?
Observational (n=391)
No
What are the prevalence, predictors, and management outcomes of left atrial appendage thrombogenic milieu in non-valvular atrial fibrillation patients with low to moderate thromboembolic risk?
Effect estimate: OR 3.121 (95% CI 1.205-8.083)
p-value: p=0.019
In NVAF patients with low to moderate thromboembolic risk, LAA thrombogenic milieu is present in 11% and is predicted by non-paroxysmal AF and enlarged left atrium, but resolves effectively with short-term OAC.
Non-paroxysmal AF was associated with higher LAA thrombogenic milieu odds in low-moderate risk NVAF; leaves open whether targeted screening or OAC alters outcomes.
BACKGROUND: The present study aimed to investigate the prevalence, predictors, and management of left atrial appendage (LAA) thrombogenic milieu (TM) identified with transesophageal echocardiography (TEE) in non-valvular atrial fibrillation (NVAF) patients with low to moderate thromboembolic (TE) risk. METHODS: -VASc score. LAA TM was defined as LAA thrombus (LAAT), sludge or spontaneous echo contrast (SEC). Management of LAA TM was at the discretion of the treating physician. RESULTS: A total of 43 patients (11.0%) were detected with LAA TM, including 5 with LAAT (11.6%), 4 with LAAT + Sect. (9.3%), 3 with sludge (7.0%), and 31 with Sect. (72.1%). In multivariate model, non-paroxysmal AF (OR 3.121; 95% CI 1.205-8.083, p = 0.019), and a larger left atrial diameter (LAD) (OR 1.134; 95% CI 1.060-1.213, p < 0.001) were significantly associated with the presence of LAA TM. All LAATs or sludges effectively resolved after mean duration of 117.5 ± 20.0 days for oral anticoagulant (OAC) medication. TE events occurred in 3 patients (18.8%) among those discontinuing OAC over a mean follow-up of 26.2 ± 8.8 months, while no TE events occurred in patients with continuous OAC. CONCLUSIONS: LAA TM could be identified in 11.0% in NVAF patients with low to moderate TE risk, especially in those with non-paroxysmal AF and enlarged LAD. Short-term OAC medication could effectively resolve the LAAT or sludge.
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Qiao et al. (2023) conducted an observational in Non-valvular atrial fibrillation with low to moderate thromboembolic risk (n=391). Non-paroxysmal AF vs. Paroxysmal AF was evaluated on Presence of left atrial appendage thrombogenic milieu (OR 3.121, 95% CI 1.205-8.083, p=0.019). In patients with non-valvular atrial fibrillation and low to moderate thromboembolic risk, non-paroxysmal AF significantly increased the risk of left atrial appendage thrombogenic milieu (OR 3.121).
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