The left atrial appendage thrombosis of in patients with persistent atrial fibrillation after the novel coronavirus infection

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Persistent atrial fibrillation (n=128). Intervention: Prior COVID-19 infection vs. No prior COVID-19 infection. Primary outcome: Left atrial appendage thrombosis (p=0.030).

Е. С. Мазур; В. В. Мазур; N. D. Bazhenov; Marina A. Kunitsina

doi:10.18087/cardio.2022.3.n1790

March 31, 2022KardiologiiaOpen Access

The left atrial appendage thrombosis of in patients with persistent atrial fibrillation after the novel coronavirus infection

View Full Paper

Ask AI

Bookmark

Share

Key result

Prior COVID-19 infection in patients with persistent atrial fibrillation was associated with a significantly higher rate of left atrial appendage thrombosis compared to those without prior infection (19.4% vs 6.5%, p=0.030).

Why the study?

The incidence and clinical features of left atrial appendage thrombosis in patients with persistent atrial fibrillation following COVID-19 required evaluation.

Does a history of COVID-19 increase the incidence of left atrial appendage thrombosis in patients with persistent atrial fibrillation?

Study Design

Type

Observational (n=128)

Multicenter

No

Structured PICO

Does a history of COVID-19 increase the incidence of left atrial appendage thrombosis in patients with persistent atrial fibrillation?

P

Population

128 patients with persistent atrial fibrillation scheduled for cardioversion, including 36 who recovered from COVID-19, evaluated for left atrial appendage thrombosis.

E

Exposure

History of COVID-19 infection

C

Comparator

No history of COVID-19 infection

O

Outcome

Incidence and features of left atrial appendage (LAA) thrombosis detected by transesophageal echocardiographysurrogate

Main Result

Absolute Event Rate: 19.4% vs 6.5%

p-value: p=0.030

Patients with persistent atrial fibrillation who recovered from COVID-19 have a higher incidence of left atrial appendage thrombosis with atypical mural localization despite preserved LAA blood flow velocity.

Limitations

Small number of observations of LAA thrombosis in patients with persistent AF who recovered from COVID-19
Results cannot be extrapolated to the entire population of such patients without confirmation from independent studies
Small number of LAA thrombosis observations in post-COVID-19 patients
Requires confirmation by other independent studies

Implication

May warrant closer LAA evaluation in post-COVID persistent AF; leaves open causal confirmation and practice implications.

Abstract

Aim To evaluate the incidence and features of left atrial appendage (LAA) thrombosis in patients with persistent atrial fibrillation (AF) after novel coronavirus infection (COVID-19).Material and methods Percutaneous echocardiography (pcEchoCG) was performed for 128 patients with persistent AF prepared for cardioversion, 36 (28.1 %) of whom had had COVID-19. In 3 (8.3 %) patients, the lung lesion area was 50-75 %; in 31 (86.1 %) patients, 25-50 %; in 1 (2.8 %) patient, less than 25 %. One patient had no lung lesion. Median time from the onset of COVID-19 to the patient enrollment in the study was 76.5 days. At the time of enrollment, the polymerase chain reaction test for SARS-CoV-2 was negative in all patients.Results Patients after COVID-19 and those who had not had COVID-19 were comparable by age (62.5±9.2 and 62.4±9.1 years, respectively; р=0.956), gender (men 52.8 and 59.8 %, respectively; р=0.471), and risk of stroke (score 2.19±1.28 and score 1.95±1.35, respectively; р=0.350). Duration of the last arrhythmia episode was longer for patients after COVID-19 than for the comparison group (76.5 and 45.0 days, respectively; р=0.011). All patients received oral anticoagulants. 55.6 % of COVID-19 patients received rivaroxaban, whereas 62.0% of patients who had not had COVID-19 were treated with apixaban. Median duration of the anticoagulant treatment was longer for COVID-19 patients than for the comparison group (61.5 and 32.0 days; р=0.051). LAA thrombus was detected in 7 (19.4 %) patients after COVID-19 and in 6 (6.5 %) patients of the comparison group (р=0.030). In COVID-19 patients, the thrombus adhered to LAA wall over the entire thrombus length whereas in patients who had not have COVID-19, the thrombus had a free part that formed a sharp angle with LAA walls. In the presence of LAA thrombus, the LAA blood flow velocity was considerably higher for COVID-19 patients than for the comparison group (31.0±8.9 and 18.8±4.9 cm/sec, respectively; p=0.010). At the follow-up examination performed at 24.0 days on the average, the thrombus was found to be dissolved in 80 and 50% of patients after and without COVID-19, respectively (р=0.343).Conclusion In patients with persistent AF after the novel coronavirus infection, LAA thrombosis was detected more frequently than in patients who had never had COVID-19; it was characterized by mural localization and was not associated with a decrease in LAA blood flow velocity.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Мазур et al. (2022) conducted an observational in Persistent atrial fibrillation (n=128). Prior COVID-19 infection vs. No prior COVID-19 infection was evaluated on Left atrial appendage thrombosis (p=0.030). Prior COVID-19 infection in patients with persistent atrial fibrillation was associated with a significantly higher rate of left atrial appendage thrombosis compared to those without prior infection (19.4% vs 6.5%, p=0.030).

synapsesocial.com/papers/6a7c4896f92b625ceba1609d https://doi.org/10.18087/cardio.2022.3.n1790