title: Atrial fibrillation ablation in patients with known sludge in the left atrial appendage.
abstract: OBJECTIVE
  Transesophageal echocardiography (TEE) is routinely used to assess for thrombus in the left atrium (LA) and left atrial appendage (LAA) in patients undergoing atrial fibrillation (AF) ablation. However, little is known about the outcome of AF ablation in patients with documented LAA sludge. We hypothesize that AF ablation can be performed safely in a proportion of patients with sludge in the LAA and may have a significant benefit for these patients.
  
  
  METHODS
  We performed a retrospective analysis of all patients undergoing AF ablation at New York University Langone Medical Center (NYULMC) from January 1st 2011 to June 30, 2013. Patients with sludge found on their TEE immediately prior to AF ablation were identified and followed for stroke, AF recurrence, procedural complications, major bleeding, or death.
  
  
  RESULTS
  Among 1,076 patients who underwent AF ablation, 8 patients (mean age 69 ± 13 years; 75 % men) with sludge were identified. Patients with sludge in their LAA had no incidence of early or late occurrence of stroke during mean follow-up of 10 months. One patient had a left groin hematoma, and two patients had atrial tachycardias that needed a repeat ablation. TEE at the time of repeat ablation demonstrated the presence of spontaneous echo contrast (smoke) and resolution of sludge. There were no deaths.
  
  
  CONCLUSIONS
  In a cohort of eight patients with LAA sludge who underwent AF ablation, no significant thromboembolic events occurred during or after the procedure. AF ablation can be performed safely and may be beneficial in these patients. Larger studies are warranted to better determine the most appropriate management route.
authors.affiliation: Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hajjiri
authors.forename: Scott
authors.initials: S
authors.lastname: Bernstein
authors.forename: Muhamed
authors.initials: M
authors.lastname: Saric
authors.forename: Ricardo
authors.initials: R
authors.lastname: Benenstein
authors.forename: Anthony
authors.initials: A
authors.lastname: Aizer
authors.forename: Glenn
authors.initials: G
authors.lastname: Dym
authors.forename: Steven
authors.initials: S
authors.lastname: Fowler
authors.forename: Douglas
authors.initials: D
authors.lastname: Holmes
authors.forename: Neil
authors.initials: N
authors.lastname: Bernstein
authors.forename: Mark
authors.initials: M
authors.lastname: Mascarenhas
authors.forename: David
authors.initials: D
authors.lastname: Park
authors.forename: Larry
authors.initials: L
authors.lastname: Chinitz
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality*; D015897:Comorbidity; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000401:mortality*; D015996:Survival Rate; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D016896:Treatment Outcome
references.citation: J Am Soc Echocardiogr. 2014 Nov;27(11):1176-83
references.pmid: 25262162
references.citation: J Cardiovasc Med (Hagerstown). 2009 Jul;10(7):523-8
references.pmid: 19474574
references.citation: JAMA. 2001 May 9;285(18):2370-5
references.pmid: 11343485
references.citation: Europace. 2012 Apr;14(4):528-606
references.pmid: 22389422
references.citation: J Cardiovasc Electrophysiol. 2011 Aug;22(8):839-45
references.pmid: 21410581
references.citation: J Am Coll Cardiol. 2001 Mar 1;37(3):691-704
references.pmid: 11693739
references.citation: Circulation. 1996 Mar 15;93(6):1262-77
references.pmid: 8653857
references.citation: Heart. 2003 Dec;89(12):1447-54
references.pmid: 14617563
references.citation: Ann Intern Med. 1997 Feb 1;126(3):200-9
references.pmid: 9027270
references.citation: J Am Coll Cardiol. 2006 Nov 21;48(10):2077-84
references.pmid: 17112997