Abstract
Objectives: Spontaneous echo contrast (SEC) in the left atrium (LA) is frequently observed in atrial fibrillation (AF) patients and may lead to thromboembolic events. We aimed to investigate both periprocedural and long-term stroke risks associated with LA SEC in AF patients undergoing percutaneous left atrial appendage closure (LAAC).Methods: A total of 408 consecutive AF patients treated with LAAC between March 2015 and February 2019 were divided into two groups based on preprocedural transesophageal echocardiography: the study group (moderate/severe LA SEC; n = 41) and the control group (none, mild, or mild to moderate LA SEC; n = 367). To attenuate the observed imbalance in baseline covariates, a propensity score matching technique was used.Results: No periprocedural stroke/transient ischemic attack (TIA) was documented. The incidence of device-related thrombus was higher in the study group than in the control group (8.8 vs. 1.3%; P = 0.025). The mean follow-up period was 3.2 ± 1.1 years, during which 8 patients (2.2%) in the control group and 4 (9.8%) in the study group experienced stroke/TIA (P = 0.024). Moderate/severe LA SEC was identified as an independent predictor of stroke/TIA in both the original population (HR = 5.71, 95% CI 1.47–22.19, P = 0.012) and the matched population (HR = 9.79, 95% CI 1.44–66.86, P = 0.020).Conclusions: LA SEC did not show a relationship with periprocedural stroke events in patients undergoing percutaneous LAAC. However, moderate/severe LA SEC increased the incidence of device-related thrombus and the risk of late stroke/TIA.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia in the clinical setting [1]
Moderate/severe left atrium (LA) Spontaneous echo contrast (SEC) was detected in 41 patients (10.0%) on transesophageal echocardiography (TEE) performed at baseline; the control group included 367 patients (Figure 1)
Multivariable Cox regression analysis indicated that moderate/severe LA SEC was an independent predictor of stroke/transient ischemic attack (TIA) in the current study
Summary
Atrial fibrillation (AF) is the most common arrhythmia in the clinical setting [1]. Ischemic stroke is one of the most serious complications of AF [2]. The majority of thrombi originate from the left atrial appendage (LAA) [3]. The anticoagulation treatment strategy is typically chosen based on the CHA2DS2-VASc score in patients with AF. Spontaneous echo contrast (SEC) in the left atrium (LA) is frequently observed on transesophageal echocardiography (TEE) in AF patients. Gedikli et al reported that the presence of dense LA SEC did not show any correlation with periprocedural thromboembolic events in AF patients undergoing catheter ablation with uninterrupted anticoagulation. A significant association was observed with late stroke/transient ischemic attack (TIA) [5]
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