Key result
Low-dose isoproterenol reduces spontaneous echo contrast, allowing LAA thrombus exclusion in 88% of patients.
Why the study?
In AF patients with severe LAA blood stasis, dense spontaneous echo contrast disturbs distinct visualization of the LAA interior, making thrombus diagnosis inconclusive.
Does low-dose isoproterenol infusion reduce dense spontaneous echo contrast to exclude left atrial appendage thrombus in patients with atrial fibrillation?
Observational (n=17)
Open-label
No
Does low-dose isoproterenol infusion reduce dense spontaneous echo contrast to exclude left atrial appendage thrombus in patients with atrial fibrillation?
Low-dose isoproterenol infusion during transesophageal echocardiography safely and effectively reduces dense spontaneous echo contrast, allowing for the exclusion of left atrial appendage thrombus in patients with atrial fibrillation.
Answers are grounded in this paper and cite their sources.
May facilitate LAA thrombus exclusion on TEE in AF; hypothesis-generating and requires prospective validation.
BACKGROUND: In patients with atrial fibrillation (AF) and severe blood stasis in the left atrial appendage (LAA), dense spontaneous echo contrast (SEC) disturbs the distinct visualization of the LAA interior, thus making thrombus diagnosis inconclusive. We aimed to prospectively assess the efficacy and safety of a protocol for a low-dose isoproterenol (ISP) infusion to reduce SEC to exclude an LAA thrombus. METHODS AND RESULTS: We enrolled 17 patients with AF and dense SEC (Grade 4 or sludge). ISP was infused with gradually increasing doses of 0.01, 0.02, and 0.03 μg/kg/min at 3-min intervals. After increasing the dose to 0.03 μg/kg/min for 3 min, or when the LAA interior was visible, the infusion was terminated. We reassessed the SEC grade, presence of an LAA thrombus, LAA function, and left ventricular ejection fraction (LVEF) within 1 min of ISP termination. Compared with baseline, ISP significantly increased LAA flow velocity, the LAA emptying fraction, LAA wall velocities, and LVEF (all P<0.01). ISP administration significantly reduced the SEC grade (median) from 4 to 1 (P<0.001). The SEC grade decreased to ≤2 in 15 (88%) patients, and the LAA thrombus was excluded. There were no adverse events. CONCLUSIONS: Low-dose ISP infusion may be effective and safe to reduce SEC and exclude an LAA thrombus by improving LAA function and LVEF.
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Machino‐Ohtsuka et al. (2023) conducted an observational in Atrial fibrillation with dense spontaneous echo contrast (n=17). Isoproterenol vs. Baseline was evaluated on Change in spontaneous echo contrast (SEC) grade (p=<0.001). Low-dose isoproterenol infusion significantly reduced the median spontaneous echo contrast grade from 4 to 1 (P<0.001), allowing the exclusion of a left atrial appendage thrombus in 88% of patients.
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