Left Atrial Thrombosis before Catheter Ablation or Cardioversion in Patients with Non-valvular Atrial Fibrillation or Atrial Flutter: what Risk Score is Most Informative?

Abstract

Aim. To compare different scores in assessment of risk of left atrial or its appendage thrombosis (LAAT) in patients with non-valvular atrial fibrillation (AF) or atrial flutter (AFL) undergoing transesophageal echocardiography before catheter ablation (CA) or cardioversion (CV).Material and methods. In retrospective, single-center, case-control study medical records of 1994 patients with non-valvular AF or AF from the period 2014-2019, who underwent transesophageal echocardiography before CA or elective CV, were analyzed. LAAT was detected in 33 of them. For the control group, 167 patients without LAAT were randomly selected from this database. CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were evaluated and compared as potential predictors of LAAT.Results. Mean age of studied patients (n=200) was 60.3±10.9, 55% of them were males. Most of patients had non-valvular AF (87,5%) and were assessed before CA (84,0%). All risk scores were associated with LAAT and CHA2DS2-VASc-RAF score was most informative [AUC 0.84; 95% confidence interval (CI) 0.76-0.91]. According to multivariate analysis in a logistic regression model among studied risk scores CHA2DS2-VASc-RAF score was the single independent predictor of LAAT [odds ratio (OR) 1.37; 95% CI 1.21-1.55; p=0.004). OR of LAAT among patients with CHA2DS2-VASc-RAF >3 was 12.8 (95% CI 3.75-43.9; p<0.0001) with sensitivity, specificity, positive and negative predicting values 90.6%, 57.1%, 30.2% and 96.7% respectively Conclusion. In the studied group of patients with non-valvular AF or AFL, without severe structural heart disease and severe concomitant diseases CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were associated with LAAT. CHA2DS2-VASc-RAF score was the most informative. >˂0.0001) with sensitivity, specificity, positive and negative predicting values 90.6%, 57.1%, 30.2% and 96.7% respectively.Conclusion. In the studied group of patients with non-valvular AF or AFL, without severe structural heart disease and severe concomitant diseases CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were associated with LAAT. CHA2DS2-VASc-RAF score was the most informative.