Incidence and predictors of left atrial thrombus in patients with atrial fibrillation prior to ablation in the real world of China
| Autor: | Sen Lei, Yongyue Tian, Fengpeng Jia, Yuan Yang, Quan He, Suxin Luo |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty Radiofrequency ablation medicine.medical_treatment 030204 cardiovascular system & hematology Cardioversion law.invention CHADS2 score 03 medical and health sciences 0302 clinical medicine law Physiology (medical) Internal medicine medicine 030212 general & internal medicine cardiovascular diseases Thrombus Transesophageal echocardiography Stroke Univariate analysis CHA2DS2VASC score Proportional hazards model business.industry Atrial fibrillation medicine.disease Left atrial or left atrial appendage thrombus lcsh:RC666-701 Heart failure Cardiology cardiovascular system Original Article Cardiology and Cardiovascular Medicine business |
| Zdroj: | Indian Pacing and Electrophysiology Journal Indian Pacing and Electrophysiology Journal, Vol 19, Iss 4, Pp 134-139 (2019) |
| ISSN: | 0972-6292 |
| Popis: | Background: The present study was to evaluate the value of CHADS2 and CHA2DS2VASC scores on predicting left atrial (LA) or left atrial appendage (LAA) thrombus in atrial fibrillation (AF) patients prior to ablation in the real world of China. Methods and results: A total of 397 patients with non-valvular AF were analyzed to determine the relationship between CHADS2 and CHA2DS2VASC scores and LA/LAA thrombus identified on transesophageal echocardiography prior to radiofrequency ablation(RFA). LA/LAA thrombus was present in 38 patients (9.6%). There was a strong association between higher CHADS2 score or CHA2DS2VASC score and LA/LAA thrombus. No thrombus was identified in patients with CHA2DS2VASC score of 0 regardless of anticoagulation status. However, LA/LAA thrombus was detected in 2.9% patients with CHADS2 score of 0 without adequate anticoagulation, while no thrombus was present in the patients with CHADS2 score of 0 with adequate anticoagulation. Univariate analysis showed that heart failure (LVEF＜50%), LA≥40 mm, diabetes mellitus, previous stroke or TIA, CAD, hypertension, inadequate anticoagulation therapy, CHADS2 score of ≥2 and CHA2DS2VASC score of ≥2 were significantly associated with LA/LAA thrombus. Multivariable Cox regression analysis demonstrated that CHA2DS2VASC score of ≥2 (p = 0.02) and previous stroke or TIA (p = 0.04) were independently associated with LA/LAA thrombus regardless of anticoagulation status. ROC curve analysis showed that higher CHADS2 score and CHA2DS2VASC score could be similarly used to predict the presence of LA thrombus. Conclusions: Both higher CHA2DS2VASC and CHADS2 scores were associated with LA/LAA thrombus in non-valvular AF patients prior to ablation. Although CHA2DS2VASC score and CHADS2 score had similar value to predict LA/LAA thrombus, CHA2DS2VASc score was better to identify low-risk patients for LA/LAA thrombus than CHADS2 score without anticoagulation. There will be a possibility of performing AF ablation or cardioversion in patients with a CHA2DS2VASC of 0 without TEE or anticoagulation therapy. The safety need to be verified by more multicentre randomized controlled clinical trails. Keywords: Atrial fibrillation, Left atrial or left atrial appendage thrombus, Transesophageal echocardiography, CHADS2 score, CHA2DS2VASC score |
| Databáze: | OpenAIRE |
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