title: Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: beyond the CHA2DS2VASc score.
abstract: BACKGROUND
  Atrial fibrillation (AF) increases the risk of thromboembolic events by promoting clot formation in the left atrial appendage (LAA). Transesophageal echocardiography (TEE) is routinely used to exclude the presence of an LAA thrombus before AF ablation. So far, it has not been established what is the optimal combination of noninvasive parameters for thromboembolic risk stratification in this setting and whether patients at very low risk require TEE.
  
  
  OBJECTIVE
  The aim of the study was to assess predisposing factors for an LAA thrombus in patients scheduled for AF ablation and to identify those patients in whom preprocedural TEE is not necessary.
  
  
  METHODS
  In consecutive 151 patients (107 men; mean age, 57 ±10 years) the type of AF and renal function were assessed in addition to the CHA2DS2VASc score to improve thromboembolic risk stratification.
  
  
  RESULTS
  An LAA thrombus or dense echo contrast with a strong suspicion of a probable thrombus was detected in 15 patients (10%). Diabetes, age of 65 years or older, persistent AF, and estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2 were predictors of the LAA thrombus. A multivariate logistic regression analysis showed that only persistent AF and an eGFR of less than 60 ml/min/1.73 m2 were independent predictors of the LAA thrombus. The receiver operating characteristic curves showed that the greatest area under the curve (0.845) was achieved for the CHA2DS2VASc-AFR (CHA2DS2VASc plus the type of AF and renal function); the difference was not significant. A CHA2DS2VASc-AFR score of 2 or greater or a CHA2DS2VASc score of 1 or greater identified patients with the LAA thrombus with a sensitivity of 100% (and specificity of 54% and 36%, respectively).
  
  
  CONCLUSIONS
  In patients scheduled for AF ablation, an LAA thrombus or dense echo contrast is a relatively common finding despite routine anticoagulant treatment. The addition of AF type and renal function to the CHA2DS2VASc score slightly improves thromboembolic risk stratification and may help identify patients who do not need preprocedural TEE.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sikorska
authors.forename: Jakub
authors.initials: J
authors.lastname: Baran
authors.forename: Ewa
authors.initials: E
authors.lastname: Pilichowska-Paszkiet
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Sikora-Frąc
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kryński
authors.forename: Roman
authors.initials: R
authors.lastname: Piotrowski
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stec
authors.forename: Beata
authors.initials: B
authors.lastname: Zaborska
authors.forename: Piotr
authors.initials: P
authors.lastname: Kułakowski
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*