Abstract 18114: Prevalence of Left Atrial Appendage Thrombus in Oncologic Patients with Atrial Fibrillation

Abstract

Introduction: There is considerable evidence that the left atrial appendage (LAA) is a common site for thrombus formation and its characteristics pose varying risks for having embolic events. Furthermore, atrial fibrillation has been found to occur with an increased frequency in patients with malignancies. The lack of evidence of standardized treatment strategies in the cancer population forces physicians to take an individualized approach to atrial fibrillation and stroke prevention. Herein, we describe the LAA characteristics in a cancer population with atrial fibrillation. Hypothesis: Cancer patients have an increased risk of LAA thrombus formation in atrial fibrillation. Methods: This is a retrospective study to determine the prevalence of LAA thrombus in a cohort of oncologic patients with atrial fibrillation. Two hundred and forty-five patients underwent transesophageal echocardiogram (TEE) at MD Anderson Cancer Center during the period 2000-2013 for atrial fibrillation evaluation. Results: LAA thrombus was identified in 6.5% of patients (16 of 245). During follow up, three of these patients had experienced a stroke (19%). The mean age was 67 with 5 females (31%) and 11 males (69%). Fifteen patients were white. The majority of patients had solid tumors (75%, 12 of 16). The mean CHADS2 score was 1.3 +/- 0.9 and the mean left ventricular ejection fraction on transthoracic echo was 57 +/- 9%. Spontaneous echo contrast was noted on TEE in 56% of patients (9 of 16). Five patients were on antiplatelet therapy and 9 were on oral anticoagulants. Oncologic, TEE, and clinical data are detailed below (Table 1). Conclusions: The prevalence of LAA thrombus and stroke in cancer patients with atrial fibrillation is significant. These findings may be a reflection of the enhanced inflammatory state of cancer. This data suggest that LAA thrombus evaluation is critical in determining the anticoagulation strategy in atrial fibrillation patients with cancer.