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June 12, 2026Journal of Clinical MedicineOpen Access

Left Atrial Appendage Thrombus and Dense Spontaneous Echo Contrast in Anticoagulated Atrial Fibrillation Patients Referred for Cardioversion: Beyond CHA2DS2-VASc and Cardiac Implantable Electronic Devices

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Key result

Higher LVEF linked to ~5% lower LAAT or dense SEC risk per 1% increase in AF.

  • OR 0.95
  • 95% CI 0.94-0.97
  • P<0.0001
  • n=510

Why the study?

What are the clinical and echocardiographic determinants of left atrial appendage thrombus and/or dense spontaneous echocardiographic contrast in adequately anticoagulated patients with persistent atrial fibrillation referred for cardioversion?

Population

510 consecutive patients with persistent AF anticoagulated for at least 3 weeks prior to elective DCCV

Design

Prospective observational study

Authors

KGKinga Gościńska-BisMPMichał PieczaraJPJolanta Pol-Romik

Discussion

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Overview

Lower LVEF may flag higher LAAT/SEC risk; leaves open whether LVEF refines TEE or anticoagulation decisions in AF.

Key Points

  • This study aims to identify clinical and echocardiographic predictors of left atrial appendage thrombus and dense spontaneous echo contrast in anticoagulated atrial fibrillation patients.
  • Prospective observational study of 510 patients with persistent atrial fibrillation
  • Patients received at least 3 weeks of effective anticoagulation and underwent echocardiography before cardioversion
  • Independent predictors were identified using multivariable logistic regression.
  • LAAT and/or dense SEC were found in 37.6% of patients, with 73 having overt LAAT
  • Lower left ventricular ejection fraction (OR 0.95), reduced right ventricular fractional area change (OR 0.93), and larger left atrial area (OR 1.05) were identified as independent predictors
  • Moderate or greater mitral regurgitation was associated with lower risk (OR 0.50), while CHA2DS2-VASc score and right ventricular leads were not predictive.

Study Design

Type

Observational (n=510)

Structured PICO

What are the clinical and echocardiographic determinants of left atrial appendage thrombus and/or dense spontaneous echocardiographic contrast in adequately anticoagulated patients with persistent atrial fibrillation referred for cardioversion?

P
Population
510 consecutive patients with persistent atrial fibrillation on at least 3 weeks of effective anticoagulation referred for elective direct current cardioversion.
O
Outcome
Presence of left atrial appendage thrombus (LAAT) and/or dense spontaneous echocardiographic contrast (SEC) (Fatkin grade 3–4)surrogate

Main Result

Odds Ratio: 0.95 (95% CI 0.94–0.97)

p-value: p=<0.0001

In anticoagulated patients with persistent AF, LAAT or dense SEC is common and primarily driven by echocardiographic markers of biventricular dysfunction and left atrial remodeling rather than traditional clinical risk scores.

Cite This Study

Gościńska-Bis et al. (2026) conducted an observational in persistent atrial fibrillation (n=510). Left ventricular ejection fraction was evaluated on presence of LAAT and/or dense SEC (Fatkin grade 3–4) (OR 0.95, 95% CI 0.94-0.97, p=<0.0001). In anticoagulated patients with persistent AF, left ventricular ejection fraction was inversely associated with LAAT or dense SEC (OR 0.95 per 1% increase; 95% CI 0.94-0.97; p<0.0001).

synapsesocial.com/papers/6a2bd11d6550ea4541ffe8e7https://doi.org/10.3390/jcm15124500
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