Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography
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Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography. / Gunawardene, Melanie A; Dickow, Jannis; Schaeffer, Benjamin N; Akbulak, Ruken Ö; Lemoine, Marc D; Nührich, Jana M; Jularic, Mario; Sinning, Christoph; Eickholt, Christian; Meyer, Christian; Moser, Julia M; Hoffmann, Boris A; Willems, Stephan.
In: J CARDIOVASC ELECTR, Vol. 28, No. 10, 10.2017, p. 1127-1136.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography
AU - Gunawardene, Melanie A
AU - Dickow, Jannis
AU - Schaeffer, Benjamin N
AU - Akbulak, Ruken Ö
AU - Lemoine, Marc D
AU - Nührich, Jana M
AU - Jularic, Mario
AU - Sinning, Christoph
AU - Eickholt, Christian
AU - Meyer, Christian
AU - Moser, Julia M
AU - Hoffmann, Boris A
AU - Willems, Stephan
N1 - © 2017 Wiley Periodicals, Inc.
PY - 2017/10
Y1 - 2017/10
N2 - INTRODUCTION: The need for transesophageal echocardiography (TEE) before catheter ablation of atrial fibrillation (CA-AF) is still being questioned. The aim of this study is to analyze patients' (patients) risk factors of left atrial appendage thrombus (LAAT) prior to CA-AF in daily clinical practice, according to oral anticoagulation (OAC) strategies recommended by current guidelines.METHODS AND RESULTS: All patients scheduled for CA-AF from 01/2015 to 12/2016 in our center were included and either treated with NOACs (novel-OAC; paused 24-hours preablation) or continuous vitamin K antagonists (INR 2.0-3.0). All patients received a preprocedural TEE at the day of ablation. Two groups were defined: (1) patients without LAAT, (2) patients with LAAT. The incidence of LAAT was 0.78% (13 of 1,658 patients). No LAAT was detected in patients with a CHA2 DS2 -VASc score of ≤1 (n = 640 patients) irrespective of the underlying AF type. Independent predictors for LAAT are: higher CHA2 DS2 -VASc scores (odds ratio [OR] 1.54, 95%-confidence interval [CI]: 1.07-2.23, P = 0.0019), a history of nonparoxysmal AF (OR 7.96, 95%-CI: 1.52-146.64, P = 0.049), hypertrophic cardiomyopathy (HCM; OR 9.63, 95% CI: 1.36-43.05, P = 0.007), and a left ventricular ejection fraction (LVEF) < 30% (OR 8.32, 95% CI: 1.18-36.29, P = 0.011). The type of OAC was not predictive (P = 0.70).CONCLUSIONS: The incidence of LAAT in patients scheduled for CA-AF is low. Therefore, periprocedural OAC strategies recommended by current guidelines seem feasible. Preprocedural TEE may be dispensed in patients with a CHA2 DS2 -VASc score ≤1. However, a CHA2 DS2 -VASc score ≥2, reduced LVEF, HCM, or history of nonparoxysmal AF are independently associated with an increased risk for LAAT.
AB - INTRODUCTION: The need for transesophageal echocardiography (TEE) before catheter ablation of atrial fibrillation (CA-AF) is still being questioned. The aim of this study is to analyze patients' (patients) risk factors of left atrial appendage thrombus (LAAT) prior to CA-AF in daily clinical practice, according to oral anticoagulation (OAC) strategies recommended by current guidelines.METHODS AND RESULTS: All patients scheduled for CA-AF from 01/2015 to 12/2016 in our center were included and either treated with NOACs (novel-OAC; paused 24-hours preablation) or continuous vitamin K antagonists (INR 2.0-3.0). All patients received a preprocedural TEE at the day of ablation. Two groups were defined: (1) patients without LAAT, (2) patients with LAAT. The incidence of LAAT was 0.78% (13 of 1,658 patients). No LAAT was detected in patients with a CHA2 DS2 -VASc score of ≤1 (n = 640 patients) irrespective of the underlying AF type. Independent predictors for LAAT are: higher CHA2 DS2 -VASc scores (odds ratio [OR] 1.54, 95%-confidence interval [CI]: 1.07-2.23, P = 0.0019), a history of nonparoxysmal AF (OR 7.96, 95%-CI: 1.52-146.64, P = 0.049), hypertrophic cardiomyopathy (HCM; OR 9.63, 95% CI: 1.36-43.05, P = 0.007), and a left ventricular ejection fraction (LVEF) < 30% (OR 8.32, 95% CI: 1.18-36.29, P = 0.011). The type of OAC was not predictive (P = 0.70).CONCLUSIONS: The incidence of LAAT in patients scheduled for CA-AF is low. Therefore, periprocedural OAC strategies recommended by current guidelines seem feasible. Preprocedural TEE may be dispensed in patients with a CHA2 DS2 -VASc score ≤1. However, a CHA2 DS2 -VASc score ≥2, reduced LVEF, HCM, or history of nonparoxysmal AF are independently associated with an increased risk for LAAT.
KW - Aged
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Anticoagulants/therapeutic use
KW - Atrial Appendage/diagnostic imaging
KW - Atrial Fibrillation/diagnostic imaging
KW - Cardiomyopathy, Hypertrophic/complications
KW - Catheter Ablation/methods
KW - Cohort Studies
KW - Echocardiography, Transesophageal/methods
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Precision Medicine
KW - Predictive Value of Tests
KW - Risk Assessment
KW - Stroke Volume
KW - Thrombosis/diagnostic imaging
KW - Treatment Outcome
KW - Vitamin K/antagonists & inhibitors
U2 - 10.1111/jce.13279
DO - 10.1111/jce.13279
M3 - SCORING: Journal article
C2 - 28635023
VL - 28
SP - 1127
EP - 1136
JO - J CARDIOVASC ELECTR
JF - J CARDIOVASC ELECTR
SN - 1045-3873
IS - 10
ER -
