Abstract 3064: Prognostic Significance of Left Atrial Appendage “Sludge” in Patients with Atrial Fibrillation: A New Transesophageal Echocardiographic Thromboembolic Risk Factor
Background: Among the clinical and echocardiographic indices used to stratify thromboem-bolic risk to patients with atrial fibrillation (AF), left atrial appendage (LAA) thrombus stands as the only absolute contraindication to elective cardioversion. We sought to assess the mortality and thromboembolic risk of LAA “sludge” without thrombus in patients with AF.
Methods: Three hundred and two consecutive patients (66 ± 13 yrs, 72% male) with AF undergoing transesophageal echocardiography (TEE) prior to direct current cardioversion (DCC), radiofrequency pulmonary vein isolation (PVI), or to rule out a cardioembolic source were followed for 4.2 ± 2.5 yrs. LAA sludge was defined as a dynamic, precipitous echodensity, without a discrete mass, throughout the cardiac cycle. Patients were analyzed on the basis LA/LAA thrombi (67 patients, 22%), sludge (58 patients, 19%), or spontaneous echocardiographic contrast (SEC) (70 patients, 23%) identified at their index TEE. Patients without these echocardiographic indices served as controls (107 patients, 35%).
Results: Compared with control subjects, LAA sludge was associated with older age, current smoking, previous thromboembolism, heart failure, and ischemic heart disease. The frequency and intensity of anticoagulation at their index TEE did not differ between the study groups. Multiple logistic regression analysis revealed the presence of LAA sludge as an independent predictor of all-cause mortality or thromboembolism (HR 2.22 [1.29 –3.88], p=0.004).
Conclusion: Death or thromboembolism in patients with AF and LAA sludge occurs at a high rate, comparable to thrombus, and could be considered a contraindication to DCC and PVI.