Preprocedural transesophageal echocardiogram revealed left atrial appendage thrombus in 3.6% of patients undergoing atrial fibrillation ablation despite 4 weeks of full warfarin anticoagulation.
Observational (n=192)
INTRODUCTION: Catheter-directed atrial fibrillation (AF) ablation is contraindicated among patients with left atrial appendage (LAA) thrombus. The prevalence of LAA thrombus among fully anticoagulated patients undergoing AF ablation is unknown. METHODS AND RESULTS: We retrospectively evaluated the prevalence of LAA thrombus among 192 consecutive patients undergoing AF ablation between July 2006 and January 2009. Seven of 192 patients (3.6%) had evidence of thrombus on transesophageal echocardiogram (TEE) despite being fully anticoagulated on warfarin (international normalized ratio INR 2-3) for 4 consecutive weeks prior to echocardiogram. Univariate analysis demonstrated that structural heart disease, large left atrial dimension, and number of AF ablations were associated with thrombus. Three patients with thrombus had paroxysmal AF with normal LV function. CONCLUSION: Despite full anticoagulation, 3.6% of patients undergoing AF ablation had LAA thrombus. We recommend that all patients, regardless of LV function or left atrial size, should undergo preprocedural TEE to exclude the presence of LAA thrombus.
Wallace et al. (Thu,) conducted a observational in Atrial fibrillation (n=192). Warfarin anticoagulation was evaluated on Prevalence of left atrial appendage (LAA) thrombus. Preprocedural transesophageal echocardiogram revealed left atrial appendage thrombus in 3.6% of patients undergoing atrial fibrillation ablation despite 4 weeks of full warfarin anticoagulation.