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July 18, 2026Pakistan Armed Forces Medical JournalOpen Access

Predictors of Left Atrial Appendage Thrombus on Transesophageal Echocardiography before Elective Cardioversion

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Why the study?

To determine the frequency of left atrial appendage thrombus and identify its predictors on transesophageal echocardiography before elective cardioversion.

What are the clinical and echocardiographic predictors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation or flutter undergoing pre-cardioversion TEE?

Population

55 patients with non-valvular AF or atrial flutter referred for elective cardioversion

Comparison

Patients with vs without left atrial appendage thrombus

Design

Cross-sectional study

Key result

The ICMJE provides updated recommendations for best practices and ethical standards in the conduct and reporting of research published in medical journals.

Authors

THTalib HussainMSMuhammad ShabbirUFUmer Farooq

Discussion

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Overview

Higher CHA₂DS₂-VASc may flag LAA thrombus risk; hypothesis-generating only and should not yet change practice.

Key Points

  • This research aims to determine the frequency of left atrial appendage thrombus and its predictors on transesophageal echocardiography before elective cardioversion.
  • Conducted a cross-sectional study with 55 patients diagnosed with non-valvular atrial fibrillation or atrial flutter.
  • Evaluated CHA₂DS₂VASc scores, baseline lab parameters, and TEE results to assess LAA thrombus and echocardiographic features.
  • Excluded cases with valvular atrial fibrillation, recent stroke, systemic embolism, or contraindications to TEE.
  • LAA thrombus was detected in 5 (9.1%) patients undergoing TEE.
  • Patients with thrombus had higher CHA₂DS₂VASc scores (4.00 vs 2.00, p<0.05), lower LVEF (35.00% vs 58.00%, p<0.05), and increased LAVI.
  • Higher CHA₂DS₂VASc score (aOR=2.16; 95% CI: 1.01–4.41; p=0.049), lower LVEF (aOR=0.88; 95% CI: 0.85–0.97; p=0.04), and increased LAVI (aOR=1.05; 95% CI: 1.004–1.07; p=0.023) are independent predictors of LAA thrombus.

Structured PICO

What are the clinical and echocardiographic predictors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation or flutter undergoing pre-cardioversion TEE?

P
Population
55 patients with non-valvular atrial fibrillation or atrial flutter, aged 18-80 years, referred for elective cardioversion. Median age 62.00, 70.9% male. Excluded: valvular atrial fibrillation, recent stroke or systemic embolism, or contraindications to TEE.
O
Outcome
Frequency of left atrial appendage (LAA) thrombus and its predictors on transesophageal echocardiographysurrogate

Higher CHA₂DS₂-VASc scores and specific echocardiographic parameters like increased left atrial diameter and volume index independently predict left atrial appendage thrombus prior to elective cardioversion.

Cite This Study

Hussain et al. (2026) studied this question. The ICMJE provides updated recommendations for best practices and ethical standards in the conduct and reporting of research published in medical journals.

synapsesocial.com/papers/6a5b38f68167787360d24dd2https://doi.org/10.51253/pafmj.v76isuppl-7.14451
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