Abstract
Presence of left atrial appendage thrombus in patients presenting for left atrial ablation of atrial fibrillation despite pre-operative anticoagulation.
Highlights
Left atrial (LA) ablation is a key therapeutic option for the treatment of symptomatic, drugrefractory paroxysmal and persistent atrial fibrillation (AF)
In this study we have investigated the role of transesophageal echo (TEE) to detect left atrial appendage (LAA) thrombus prior to ablation for AF
Two patients might be expected to be at high risk of thrombus with impaired LV function and either a massively dilated LA or the presence of multiple risk factors for embolic events, thrombus was identified in two patients with paroxysmal AF and a normal left ventricular ejection fraction
Summary
Left atrial (LA) ablation is a key therapeutic option for the treatment of symptomatic, drugrefractory paroxysmal and persistent atrial fibrillation (AF). Left atrial (LA) thrombus, which may be dislodged by catheter manipulation, is an absolute contraindication to ablation It is unclear whether imaging of the left atrial appendage (LAA) by transesophageal echo (TEE) is mandatory to exclude LA clot prior to ablation, in “low-risk” patients with paroxysmal AF and normal left ventricular (LV) function. Despite at least 4 weeks of preoperative therapeutic anticoagulation with Warfarin (INR>2.0), LAA thrombus was identified in 4 patients (2.7% (0.1-5.3%)) These included 2 patients with paroxysmal AF and normal LV function, both had a high arrhythmia burden. Conclusions: Pre-operative imaging of the LAA remains advisable to exclude thrombus prior to ablation for AF even in patients with paroxysmal AF and normal LV function, especially if there is a high AF burden
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