Key result
LAA thrombus was rare (0.5%) before elective catheter ablation, with underlying rhythm and reduced kidney function significantly associated with reduced LAA flow and thrombus presence (p=0.003).
Why the study?
TEE is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out left atrial thrombi, but data supporting this practice are inconsistent.
What is the incidence and what are the predictors of left atrial appendage thrombus or reduced flow before catheter ablation of atrial tachyarrhythmias?
Observational (n=1,676)
No
What is the incidence and what are the predictors of left atrial appendage thrombus or reduced flow before catheter ablation of atrial tachyarrhythmias?
p-value: p=0.003
LAA thrombus is a rare occurrence (0.5%) before elective catheter ablation, and its likelihood is associated with the underlying rhythm and kidney function.
Rare pre-ablation LAA thrombi question routine TEE; leaves open refined selection in observational cohorts.
Introduction: Transesophageal echocardiography (TEE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of left atrial thrombi. However, data to support this practice are inconsistent. Methods: We analyzed consecutive pre-procedural TEE in a high-volume electrophysiology center for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or LAA emptying velocity (LAAEV) < 20 cm/s. The possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results: 1676 TEE were included (1122 before pulmonary vein isolation, 436 before atrial flutter ablation, 166 before other ablations). 543 patients (32%) were female and 991 (59%) were on DOAC. Nine patients (0.5%) had an LAA thrombus on pre-procedural TEE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow. The underlying rhythm showed a significant association with the presence of LAA thrombus or reduced LAA flow (p = 0.003). Patients in sinus rhythm and cavotricuspid isthmus-dependent atrial flutter exhibited the lowest risk. Additionally, reduced kidney function was associated with a reduction in LAA flow velocities (p = 0.04). Of note, two LAA thrombi occurred in patients in sinus rhythm and six out of nine patients with an LAA thrombus were on vitamin-K antagonists. Conclusions: LAA thrombus is a rare occurrence before an elective catheter ablation. The underlying rhythm and kidney function may serve as markers of a higher likelihood of significantly reduced LAAEV and LAA thrombus.
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Wegner et al. (2022) conducted an observational in Atrial tachyarrhythmias (n=1,676). Underlying rhythm and kidney function was evaluated on Presence of left atrial thrombi and relevant flow reduction in the left atrial appendage (p=0.003). LAA thrombus was rare (0.5%) before elective catheter ablation, with underlying rhythm and reduced kidney function significantly associated with reduced LAA flow and thrombus presence (p=0.003).
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