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Incidence of left atrial thrombus prior to atrial fibrillation ablation: is pre-procedural transoesophageal echocardiography mandatory?

McCready, JW; Nunn, L; Lambiase, PD; Ahsan, SY; Segal, OR; Rowland, E; Lowe, MD; (2010) Incidence of left atrial thrombus prior to atrial fibrillation ablation: is pre-procedural transoesophageal echocardiography mandatory? EUROPACE , 12 (7) 927 - 932. 10.1093/europace/euq074.

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Abstract

The exact role of transoesphageal echo (TOE) prior to atrial fibrillation (AF) ablation remains unclear. This study examines the incidence and predictors of left atrial (LA) thrombus in patients undergoing AF ablation.Patients were treated with warfarin for at least 4 weeks prior to ablation. This was substituted with therapeutic dalteparin 3 days before the procedure. All patients underwent TOE to exclude LA thrombus. Six clinical risk factors for thrombus were defined, known to be risk factors for stroke in AF: age > 75, diabetes, hypertension, valve disease, prior stroke, or transient ischaemic attack and cardiomyopathy. A total of 635 procedures were performed. The incidence of thrombus was 12/635 (1.9%) despite therapeutic anti-coagulation. Patients with thrombus had larger LA diameter, mean 50.6 +/- 6.2 mm vs. 44.2 +/- 7.6 (P = 0.006). In univariate analysis, persistent AF [odds ratio (OR) = 10.4 with 95% CI 1.8-19.1], hypertension [OR = 11.7 with 95% CI 2.5-54.1], age > 75 (OR = 4.5 with 95% CI 1.2-17.2), and cardiomyopathy (OR 5.9 with 95% CI 1.8-19.1) were significantly associated with thrombus. In multivariate analysis, hypertension (OR = 14.2 with 95% CI 2.6-77.5), age > 75 (OR = 8.1, 95% CI 1.5-44.9), and cardiomyopathy (OR = 10.5 with 95% CI 2.6-77.5) were independently associated with thrombus. There was no thrombus in patients without clinical risk factors.In patients presenting for AF ablation, LA thrombus is only seen in those with clinical risk factors. TOE is indicated in this group but may be unnecessary in patients without clinical risk factors.

Type: Article
Title: Incidence of left atrial thrombus prior to atrial fibrillation ablation: is pre-procedural transoesophageal echocardiography mandatory?
DOI: 10.1093/europace/euq074
Keywords: Atrial fibrillation, Anti-coagulation, Transoesophageal echocardiography, Fibrinolytic agents, Radiofrequency catheter ablation, PULMONARY VEIN ISOLATION, CATHETER ABLATION, APPENDAGE THROMBI, CLINICAL-TRIALS, STROKE, RISK, PREDICTORS, EFFICACY, THERAPY, ASPIRIN
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: http://discovery.ucl.ac.uk/id/eprint/1327094
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