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Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation

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Abstract

Background

The study aimed to explore the resolution of left atrial and left atrial appendage (LAA) spontaneous echo-contrast or thrombus in patients with nonvalvular atrial fibrillation/flutter (AF/AFL) under chronic oral anticoagulation (OAC).

Methods

A single-center retrospective analysis of patients who underwent a transesophageal echocardiography (TOE) for an electrical cardioversion was conducted.

Results

Among 277 TOE performed, 73 cases (26%) of LAA echo-contrast or thrombus were detected, 53 patients with LAA/LA echo-contrast (19%) and 20 (7%) with a thrombus. All patients were under chronic anticoagulation with a VKA (65%) or with a NOAC (35%). The Echo-contrast Group maintained the same OAC strategy in 49 patients (93%). The Thrombus Group kept the same OAC strategy with a NOAC in 6 cases (30%) and changed the strategy in 14 patients (70%), titrating NOAC dose in 1 (5%) and the VKA dose in 4 (20%) and switching from NOAC to VKA in 5 (25%), from VKA to NOAC in 3 (15%), and from NOAC to NOAC in 1 (5%). Smoke resolution was observed in 4/40 cases (10%) of the smoke group and thrombus resolution in 8/15 (53%) of the thrombus group. Patients with thrombus resolution had a lower CHA2DS2-Vasc score (3.5 ± 2 vs 4 ± 1, p = 0.05), were more often under NOAC (37.5 vs 28%, p = 0.07), and had a longer anticoagulation time (7.5 vs 4 months, p = 0.08).

Conclusion (s)

Changing OAC strategy is associated with thrombus resolution in more than 50% of chronically anticoagulated patients.

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Data availability

Data collected using the Estensa Software in use at the Azienda Ospedaliero Universitaria Pisana, University Hospital of Pisa.

Abbreviations

AF:

Atrial fibrillation

AFL:

Atrial flutter

LA:

Left atrium

LAA:

Left atrial appendage

LVEF:

Left ventricular ejection fraction

NOAC:

Direct oral anticoagulants

OAC:

Oral anticoagulation

SEC:

Spontaneous echo-contrast

TEE:

Transesophageal echocardiography

VKA:

Vitamin K anticoagulant

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Authors and Affiliations

  1. Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, New Santa Chiara Hospital, Via Paradisa 2, 56124, Pisa, Italy

    Andrea Di Cori, Valentina Barletta, Laura Meola, Matteo Parollo, Lorenzo Mazzocchetti, Marisa Carluccio, Giulia Branchitta, Tea Cellamaro, Francesco Gentile, Luca Segreti, Stefano Viani, Raffaele De Lucia, Ezio Soldati, Giulio Zucchelli & Maria Grazia Bongiorni

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  1. Andrea Di Cori
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Contributions

Concept/design—Andrea Di Cori, Maria Grazia Bongiorni, Giulio Zucchelli.

Data analysis/interpretation—Andrea Di Cori, Laura Meola.

Drafting article—Andrea Di Cori, Valentina Barletta.

Critical revision of article—Giulio Zucchelli, Maria Grazia Bongiorni, Stefano Viani, Luca Segreti, Raffaele De Lucia, Ezio Soldati.

Approval of article—all authors.

Statistics—Matteo Parollo, Laura Meola, Lorenzo Mazzocchetti.

Data collection—Laura Meola, Giulia Branchitta, Tea Cellamaro, Marisa Carluccio, Francesco Gentile. All authors contributed to the study conception and design. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andrea Di Cori.

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Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Di Cori, A., Barletta, V., Meola, L. et al. Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation. J Interv Card Electrophysiol 64, 773–781 (2022). https://doi.org/10.1007/s10840-022-01169-1

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