Affiliation:
1. Tver State Medical University
Abstract
Aim. To study the potential of stroke risk assessment to evaluate the probability of detecting left atrial appendage (LAA) thrombus in patients with persistent atrial fibrillation (AF) to consider performing transesophageal echocardiography (TEE) before cardioversion.Material and methods. TEE before elective cardioversion was performed in 590 patients with persistent AF, of whom 316 (53,6%) had a high stroke risk (valvular AF, hypertrophic cardiomyopathy, CHA2DS2-VASc score >1 in men and >2 in women), and 274 (46,4%) — not high. Adequate anticoagulation at least 3 weeks prior to elective cardioversion was received by 164 (51,9%) patients with a high stroke risk and 151 (55,1%) patients with a low risk. The rest of patients either did not receive adequate anticoagulation or received it for less than 3 weeks.Results. In the group of patients who received anticoagulation at least 3 weeks, LAA thrombus was detected in 23 (14,0%) patients with a high stroke risk and in 8 (5,3%) patients with a low risk (p<0,05). In patients who did not receive adequate anticoagulation or received it for less than 3 weeks, LAA thrombus was identified in 60 (39,5%) patients with a high stroke risk and in 22 (17,9%) patients with a low risk (p<0,005). Thus, a high stroke risk almost 3 times increases the likelihood of LAA thrombus detection in patients who did not receive adequate anticoagulation (odds ratio, 2,99; 95% confidence interval: 1,70-5,26;p<0,001) and in patients receiving adequate anticoagulation (odds ratio, 2,92; 95% confidence interval: 1,26-6,74; p=0,012).Conclusion. In patients with persistent AF with a low stroke risk according to CHA2DS2-VASc score, TEE before sinus rhythm restoration in patients without 3-week anticoagulation should be considered. In patients with a high stroke risk, performing pre-cardioversion TEE is advisable even after adequate anticoagulation.
Subject
Cardiology and Cardiovascular Medicine
Reference13 articles.
1. Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ.) doi:10.15829/1560-4071-2021-4594.
2. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2021;42(5):373- 498. doi:10.1093/eurheartj/ehaa612. Erratum in: Eur Heart J. 2021;42(5):507. Erratum in: Eur Heart J. 2021;42(5):546-7.
3. Zhan Y, Joza J, Al Rawahi M, et al. Assessment and management of the Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation. Can J Cardiol. 2018;34(3):252-61. doi:10.1016/j.cjca.2017.12.008.
4. Klein AL, Murray RD, Grimm RA. Role of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation. J Am Coll Cardiol. 2001;37:691-704. doi:10.1016/s0735-1097(00)01178-5.
5. Fu Y, Li K, Yang X. ABO blood groups: a risk factor for left atrial and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation. Thromb Res. 2017;156:45-50. doi:10.1016/j.thromres.2017.05.018.