Abstract 10758: Prevalence and Predictors of Left Atrial Thrombus in Patients With Atrial Fibrillation. Is Transesophageal Echocardiography Necessary before Cardioversion?
Background: Systemic embolization threatens patients (pts) with atrial fibrillation (AF). The risk is enhanced at the time of cardioversion. Transesophageal echocardiography (TEE) prior to cardioversion to screen for left atrial thrombus (LAT), a marker of high risk for embolization, is recommended for many patients with AF.
Aim: To determine clinical and echocardiographic factors associated with LAT formation in AF.
Methods: Data from 600 consecutive patients with AF undergoing TEE prior to cardioversion for the detection of LAT were analyzed. Clinical, laboratory and Echocardiographic parameters were abstracted from the clinical record.
Results: TEE identified LAT in 70 (11.6%) and dense (LA) spontaneous echo contrast (SEC) in 156(26%). Baseline characteristics and echocardiographic parameters of pts with or without LAT are compared in table. A prior myocardial infarction (p<0.001); hypertension (p 0.02); CHADS≥2 (p<0.001); lower ejection fraction (p<0.001); LA diameter (p<0.001); dense LA SEC (p<0.001) and low LA appendage emptying velocity (P<0.001) were univariately associated with LAT. Multivariate analysis was done and revealed low LA emptying velocity had the strongest independent association with LAT (HR 0.89 [CI 0.83-0.96], p value <0.001.
Conclusion: LAT may be identified in a significant minority of AF patients prior to cardioversion. The current practice of TEE examination may be justified since neither clinical nor routine 2D echo examinations reliably identify LAT.
- © 2013 by American Heart Association, Inc.