The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy
<p><strong>Introduction:</strong> The 2012 HRS/EHRA/ECAS guidelines encourage pre-procedural transesophageal echocardiography (TEE) prior to ablation for atrial fibrillation (AF), but acknowledge a lack of consensus in patients maintained on therapeutic warfarin before, during and...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
CardioFront
2013
|
| _version_ | 1797070831642214400 |
|---|---|
| author | Herring, N Page, S Ahmed, M Burg, M Hunter, R Earley, M Sporton, S Newton, J Sabharwal, N Myerson, S Bashir, Y Betts, T Schilling, R Rajappan, K |
| author_facet | Herring, N Page, S Ahmed, M Burg, M Hunter, R Earley, M Sporton, S Newton, J Sabharwal, N Myerson, S Bashir, Y Betts, T Schilling, R Rajappan, K |
| author_sort | Herring, N |
| collection | OXFORD |
| description | <p><strong>Introduction:</strong> The 2012 HRS/EHRA/ECAS guidelines encourage pre-procedural transesophageal echocardiography (TEE) prior to ablation for atrial fibrillation (AF), but acknowledge a lack of consensus in patients maintained on therapeutic warfarin before, during and after the procedure. This is partly because the incidence of left atrial appendage (LAA) thrombus is so low, that it is hard to draw clear conclusion regarding the characteristics of patients who develop thrombus. We hypothesize that the presence of low LAA emptying velocities, which predisposes to thrombus, and/or thrombus itself can be predicted in patients undergoing ablation, based upon clinical characteristics and transthoracic echocardiography (TTE).</p>
<p><strong>Methods:</strong> In this multicentre study, we undertook TTE and transesophageal echocardiograms (TEE) in 586 patients (age 59.9±0.4 years old, 64.5% male) undergoing catheter ablation for AF who were anticoagulated on warfarin (target international normalized ratio 2–3.5) for ≥3 consecutive weeks prior to procedure and maintained on warfarin for the procedure.</p>
<p><strong>Results:</strong> Low peak LAA emptying velocities (<40cm/s) were identified in 111 (24.7%) patients and LAA thrombus was identified in 3 patients (0.5%) despite having therapeutic INRs. The 3 patients with thrombus had LAA emptying velocities of 23, 29 and 31 cm/s. None of the remaining patients had a peri-procedural stroke. Patients with peak LAA emptying velocities <40cm/s or thrombus on TEE had significantly (p<0.05) higher CHA2DS2-VASc scores (1.7± 0.1 v’s 1.4±0.1), and were more likely to have impaired LVSF (odds ratio [95% CI]: 2.66 [1.52-4.66]), a LA diameter >4.6cm on TTE (2.40 [2.13-5.41]), or persistent AF (2.60 [1.63-4.14]) compared to those with a higher LAA velocity without thrombus.</p>
<p><strong>Conclusion:</strong> In patients on uninterrupted warfarin therapy, a CHA2DS2-VASc score ≥1 or LA diameter >4.6cm on TTE identifies 91.5% of those at risk of developing thrombus with LAA emptying velocity of <40 cm/s and 100% of those with thrombus in our cohort.</p> |
| first_indexed | 2024-03-06T22:44:38Z |
| format | Journal article |
| id | oxford-uuid:5cbdee89-0740-4267-aadf-3c2f2a52a46e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:44:38Z |
| publishDate | 2013 |
| publisher | CardioFront |
| record_format | dspace |
| spelling | oxford-uuid:5cbdee89-0740-4267-aadf-3c2f2a52a46e2022-03-26T17:30:06ZThe prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5cbdee89-0740-4267-aadf-3c2f2a52a46eEnglishSymplectic Elements at OxfordCardioFront2013Herring, NPage, SAhmed, MBurg, MHunter, REarley, MSporton, SNewton, JSabharwal, NMyerson, SBashir, YBetts, TSchilling, RRajappan, K<p><strong>Introduction:</strong> The 2012 HRS/EHRA/ECAS guidelines encourage pre-procedural transesophageal echocardiography (TEE) prior to ablation for atrial fibrillation (AF), but acknowledge a lack of consensus in patients maintained on therapeutic warfarin before, during and after the procedure. This is partly because the incidence of left atrial appendage (LAA) thrombus is so low, that it is hard to draw clear conclusion regarding the characteristics of patients who develop thrombus. We hypothesize that the presence of low LAA emptying velocities, which predisposes to thrombus, and/or thrombus itself can be predicted in patients undergoing ablation, based upon clinical characteristics and transthoracic echocardiography (TTE).</p> <p><strong>Methods:</strong> In this multicentre study, we undertook TTE and transesophageal echocardiograms (TEE) in 586 patients (age 59.9±0.4 years old, 64.5% male) undergoing catheter ablation for AF who were anticoagulated on warfarin (target international normalized ratio 2–3.5) for ≥3 consecutive weeks prior to procedure and maintained on warfarin for the procedure.</p> <p><strong>Results:</strong> Low peak LAA emptying velocities (<40cm/s) were identified in 111 (24.7%) patients and LAA thrombus was identified in 3 patients (0.5%) despite having therapeutic INRs. The 3 patients with thrombus had LAA emptying velocities of 23, 29 and 31 cm/s. None of the remaining patients had a peri-procedural stroke. Patients with peak LAA emptying velocities <40cm/s or thrombus on TEE had significantly (p<0.05) higher CHA2DS2-VASc scores (1.7± 0.1 v’s 1.4±0.1), and were more likely to have impaired LVSF (odds ratio [95% CI]: 2.66 [1.52-4.66]), a LA diameter >4.6cm on TTE (2.40 [2.13-5.41]), or persistent AF (2.60 [1.63-4.14]) compared to those with a higher LAA velocity without thrombus.</p> <p><strong>Conclusion:</strong> In patients on uninterrupted warfarin therapy, a CHA2DS2-VASc score ≥1 or LA diameter >4.6cm on TTE identifies 91.5% of those at risk of developing thrombus with LAA emptying velocity of <40 cm/s and 100% of those with thrombus in our cohort.</p> |
| spellingShingle | Herring, N Page, S Ahmed, M Burg, M Hunter, R Earley, M Sporton, S Newton, J Sabharwal, N Myerson, S Bashir, Y Betts, T Schilling, R Rajappan, K The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy |
| title | The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy |
| title_full | The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy |
| title_fullStr | The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy |
| title_full_unstemmed | The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy |
| title_short | The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy |
| title_sort | prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri procedural warfarin therapy |
| work_keys_str_mv | AT herringn theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT pages theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT ahmedm theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT burgm theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT hunterr theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT earleym theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT sportons theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT newtonj theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT sabharwaln theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT myersons theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT bashiry theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT bettst theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT schillingr theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT rajappank theprevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT herringn prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT pages prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT ahmedm prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT burgm prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT hunterr prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT earleym prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT sportons prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT newtonj prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT sabharwaln prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT myersons prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT bashiry prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT bettst prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT schillingr prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy AT rajappank prevalenceoflowleftatrialappendageemptyingvelocityandthrombusinpatientsundergoingcatheterablationforatrialfibrillationonuninterruptedperiproceduralwarfarintherapy |