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Atrial fibrillation ablation in patients with known sludge in the left atrial appendage

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Abstract

Purpose

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.

Conclusion

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.

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Authors and Affiliations

  1. Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA

    Mohammed Hajjiri, Scott Bernstein, Muhamed Saric, Ricardo Benenstein, Anthony Aizer, Glenn Dym, Steven Fowler, Douglas Holmes, Neil Bernstein, Mark Mascarenhas, David Park & Larry Chinitz

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  1. Mohammed Hajjiri
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  2. Scott Bernstein
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  3. Muhamed Saric
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  4. Ricardo Benenstein
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  5. Anthony Aizer
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  6. Glenn Dym
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  7. Steven Fowler
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  8. Douglas Holmes
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  9. Neil Bernstein
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  10. Mark Mascarenhas
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  11. David Park
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  12. Larry Chinitz
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Corresponding author

Correspondence to Scott Bernstein.

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Hajjiri, M., Bernstein, S., Saric, M. et al. Atrial fibrillation ablation in patients with known sludge in the left atrial appendage. J Interv Card Electrophysiol 40, 147–151 (2014). https://doi.org/10.1007/s10840-014-9892-0

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  • DOI: https://doi.org/10.1007/s10840-014-9892-0

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