Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study.
OBJECTIVE
The objective of this study was to determine the frequency of left atrial thrombus in patients with acute atrial fibrillation.


BACKGROUND
It is commonly assumed but unproved that left atrial thrombus in patients with atrial fibrillation begins to form after the onset of atrial fibrillation and that it requires > or = 3 days to form. Thus, patients with acute atrial fibrillation (i.e., < 3 days) frequently undergo cardioversion without anticoagulation prophylaxis.


METHODS
Three hundred seventeen patients (250 men, 67 women; mean [+/- SD] age 64 +/- 12 years) with acute (n = 143) or chronic (n = 174) atrial fibrillation were studied by two-dimensional transesophageal echocardiography.


RESULTS
Left atrial appendage thrombus was present in 20 patients (14%) with acute and 47 patients (27%, p < 0.01) with chronic atrial fibrillation. In patients with a recent embolic event, the frequency of left atrial appendage thrombus did not differ between those with acute (5 [21%] of 24) and those with chronic (12 [23%] of 52, p = NS) atrial fibrillation. Patients with acute versus chronic atrial fibrillation, respectively, did not differ (p = NS) in mean age (64 +/- 13 vs. 65 +/- 11 years), frequency of concentric left ventricular hypertrophy (32% vs. 26%), hypertension (32% vs. 41%), coronary artery disease (35% vs. 39%), congestive heart failure (43% vs. 48%), mitral stenosis (4% vs. 7%) or mitral valve replacement (1.4% vs. 6%). The minimally detectable difference in proportions between patients with acute and chronic atrial fibrillation based on a power of 0.80 and base proportion of 0.20 was 14%.


CONCLUSIONS
Left atrial thrombus does occur in patients with acute atrial fibrillation < 3 days in duration. The frequency of left atrial thrombus in patients with recent emboli is comparable between those with acute and chronic atrial fibrillation. These data suggest that patients with acute atrial fibrillation for < 3 days require anticoagulation prophylaxis or evaluation by transesophageal echocardiography before cardioversion and should not be assumed to be free of left atrial thrombus.
Stoddard
M F
MF
Department of Medicine, University of Louisville, Kentucky 40202.
Dawkins
P R
PR
Prince
C R
CR
Ammash
N M
NM
D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology; D002908:Chronic Disease; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors
D000925:Anticoagulants