Prevalence and clinical characteristics associated with left atrial appendage thrombus in fully anticoagulated patients undergoing catheter-directed atrial fibrillation ablation.
BACKGROUND
Catheter-directed atrial fibrillation (AF) ablation is contraindicated among patients with left atrial appendage (LAA) thrombus. The prevalence of LAA thrombus among fully anticoagulated patients undergoing AF ablation is unknown.


RESULTS
We retrospectively evaluated the prevalence of LAA thrombus among 192 consecutive patients undergoing AF ablation between July 2006 and January 2009. Seven of 192 patients (3.6%) had evidence of thrombus on transesophageal echocardiogram (TEE) despite being fully anticoagulated on warfarin (international normalized ratio [INR] 2-3) for 4 consecutive weeks prior to echocardiogram. Univariate analysis demonstrated that structural heart disease, large left atrial dimension, and number of AF ablations were associated with thrombus. Three patients with thrombus had paroxysmal AF with normal LV function.


CONCLUSIONS
Despite full anticoagulation, 3.6% of patients undergoing AF ablation had LAA thrombus. We recommend that all patients, regardless of LV function or left atrial size, should undergo preprocedural TEE to exclude the presence of LAA thrombus.
Duke Center for Atrial Fibrillation, Cardiac Electrophysiology Section of the Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA. Thomas.wallace@duke.edu
Thomas W
TW
Wallace
Brett D
BD
Atwater
James P
JP
Daubert
Deepak
D
Voora
Anna Lisa
AL
Crowley
Tristram D
TD
Bahnson
Patrick M
PM
Hranitzky
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D020517:Atrial Appendage / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D015995:Prevalence; D012189:Retrospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin