Thrombosis of the Left Atrial Appendage and Thromboembolic Events in Patients with Atrial Fibrillation: Clinical and Instrumental Correlates
- #AC/ARR 01-EP-12
- Adult Cardiac Surgery/Arrhythmias. E-POSTER (ORAL) SESSION
- E-Poster (oral)
Thrombosis of the Left Atrial Appendage and Thromboembolic Events in Patients with Atrial Fibrillation: Clinical and Instrumental Correlates
Mari G. Arakelyan, Elena Z. Golukhova, Olga I. Gromova, Naida I. Bulaeva, Tatiana V. Mashina, Violetta S. Dzhanketova, Aygerim Z. Zholbaeva, Maria A. Shlyappo
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – A
Abstract
Background. Atrial fibrillation (AF) is associated with a high risk for thromboembolic events. The
CHA 2 DS 2 VASc risk scale is very reliable, but has some limitations. Thromboembolism can occasionally
occur even in patients with AF with low CHA 2 DS 2 VASc score.
Purpose. Identification of clinical and instrumental parameters influencing the formation of
thrombosis of the left atrial appendage (LAA) and the development of thromboembolic events
in patients with atrial fibrillation without concomitant coronary artery disease and valvular
disease.
Methods. The retrospective analysis included 112 patients with AF who were hospitalized to
Bakoulev Centre of cardiovascular surgery between 2012 and 2015 for radiofrequency ablation
(RFA). All patients had proper anticoagulation. All patients underwent transthoracic
echocardiography. Contrast-enhanced computed tomography (CT) of LA was performed in 105
patients (87%) to reveal of pulmonary veins abnormality and definition one of three
morphological types of LAA. Transesophageal Echocardiography (TEE) was performed in 47
(39%) patients with calculation of left atrial appendage (LAA) blood velocity and identification
of spontaneous ECHO contrast. Fourteen patients (12%) had LAA thrombosis by TEE or CT
and/or thromboembolic (TE) complications in anamnesis (ischemic stroke or TIA).
Results. The following clinical parameters were significantly associated with LAA thrombosis
and/or ischemic stroke or TIA in anamnesis: age older than 65 years (p=0.001), obesity
(p=0.036), chronic AF (risk increases proportionally from paroxysmal to permanent type)
(p=0.003) and CHA 2 DS 2 VASc risk score (p=0,005). The following TEE parameters had predictive
value: low LAA blood flow (<30cm/s) (p=0.001), the spontaneous ECHO contrast (p=0.03).
According to CT the morphological LAA type III had a predictive value (p=0.01).
Conclusion. Thus, in addition to traditional risk factors, such as CHA 2 DS 2 VASc scale, we
identified novel predictors of LA thrombosis and/or TE events, which are: obesity, chronic AF,
low LAA blood flow velocity, the phenomenon of spontaneous ECHO contrast in LA and the
morphological LAA type III by CT.