Predictors of left atrial coagulation activity among paroxysmal atrial fibrillation patients.
BACKGROUND
The difference between left atrial (LA) and systemic coagulation activity in paroxysmal atrial fibrillation (PAF) is unclear.


RESULTS
We enrolled 100 patients with PAF who underwent AF ablation. Warfarin was stopped 1 day before the procedure. LA volume index and LA emptying fraction were measured by 64-slice multidetector computed tomography. Immediately after transseptal puncture, blood samples were simultaneously collected from the LA and systemic circulation (SC). In addition, to evaluate the effect of warfarin on D-dimer levels we recruited an additional 27 PAF patients on continuous warfarin. Even in patients with low CHADS2 scores (mean 0.59 ± 0.68) and during sinus rhythm, the prevalence of positive LA-D-dimer (≥ 0.5 µg/ml) was greater than that of SC-D-dimer (23% vs. 10%, P<0.01). The LA-D-dimer-positive patients had a larger mean LA volume index and reduced LA emptying fraction than the LA-D-dimer-negative patients. Multiple logistic regression analysis revealed that LA volume index was independently correlated with positive LA-D-dimer (odds ratio 2.245, 95% confidence interval 1.194-4.626, P=0.0112). The prevalence of positive LA-D-dimer was significantly lower in patients taking continuous warfarin, than in those on discontinuous warfarin (3.7% vs. 23%, P=0.025).


CONCLUSIONS
An enlarged LA volume index was associated with high LA coagulation status in patients with paroxysmal AF. Adequate warfarin control during AF catheter ablation may reduce the prevalence of positive LA-D-dimer.
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine.
Yoshinori
Y
Yashiro
Takanori
T
Arimoto
Naoaki
N
Hashimoto
Harutoshi
H
Tamura
Tadateru
T
Iwayama
Daisuke
D
Ishigaki
Yu
Y
Kumagai
Satoshi
S
Nishiyama
Hiroki
H
Takahashi
Tetsuro
T
Shishido
Takuya
T
Miyamoto
Tetsu
T
Watanabe
Isao
I
Kubota
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D001777:Blood Coagulation; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011517:Prothrombin Time; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D019851:Thrombophilia / Q000097:blood / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D014463:Ultrasonography; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D002317:Cardiovascular Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014859:Warfarin