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Thrombus in the left atrial appendage in patients with atrial fibrillation treated with non‐vitamin K antagonist oral anticoagulants in clinical practice—A multicenter registry
Author(s) -
Gorczyca Iwona,
Michalska Anna,
Chrapek Magdalena,
Budnik Monika,
Starzyk Katarzyna,
Jelonek Olga,
UziębłoŻyczkowska Beata,
KapłonCieślicka Agnieszka,
Gawałko Monika,
Krzesiński Paweł,
Jurek Agnieszka,
Scisło Piotr,
Kochanowski Janusz,
Kiliszek Marek,
Gielerak Grzegorz,
Filipiak Krzysztof J.,
Opolski Grzegorz,
WożakowskaKapłon Beata
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14589
Subject(s) - medicine , atrial fibrillation , rivaroxaban , cardiology , dabigatran , apixaban , thrombus , vitamin k antagonist , cardioversion , catheter ablation , warfarin
Background The prevalence and predictors of left atrial appendage thrombus (LAAT) in patients with non‐valvular atrial fibrillation (AF) who have been treated with non‐vitamin K antagonist oral anticoagulants (NOACs) are not well defined. We aimed to assess the occurrence and predictors of LAAT on transesophageal echocardiography (TOE) in patients with non‐valvular AF treated with NOACs for at least 3 weeks. Methods Consecutive patients with non‐valvular AF who underwent TOE before catheter ablation or electrical cardioversion in three high‐reference centers between 2014 and 2018 were included. Patients on apixaban were excluded from the study due to low numbers in this category. All patients received NOACs for at least 3 weeks before TOE. Results A total of 1148 patients (female, 38.1%; mean age, 62.1 years) referred to our centers for catheter ablation of AF (52.1%) or electrical cardioversion (47.9%) were included. Patients were on rivaroxaban (51.9%) or dabigatran (48.1%). Preprocedural TOE revealed LAAT in 4.4% of all patients. Multivariable logistic regression analysis showed the CHA2DS2‐VASc score ≥2 points (OR = 2.11; 95% CI, 1.15‐3.88; P = .0161), non‐paroxysmal AF (OR = 6.30; 95% CI, 2.22‐17.91; P = .0005), and GFR <60 mL/min/1.73 m 2 (OR = 2.05; 95% CI, 1.14‐3.67; P = .0160) were independent predictors of LAAT in patients treated with NOACs. Conclusions In non‐valvular AF patients treated with NOACs, the prevalence of LAAT was 4.4% before electrical cardioversion or ablation. In addition to the CHA2DS2‐VASc score, the type of AF and renal function should be considered in the stratification of thromboembolism risk in AF patients and qualification for a preprocedural TOE.