The Risk of Left Atrial Appendage Thrombus in Patients With Atrial Flutter Versus Atrial Fibrillation

IF 2.3 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Medicine Insights. Cardiology Pub Date : 2024-01-01 DOI:10.1177/11795468231221404

G. Moady, Gal Rubinstein, Loai Mobarki, A. Shturman, Tsafrir Or, S. Atar

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Abstract

Objective: Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events originating mainly from left atrial appendage thrombus (LAAT). Patients with atrial flutter (AFL) are treated with anticoagulation based on the same criteria as patients with AF. However, whether patients with AFL have similar thromboembolic risk as AF is unclear. In the current study we aimed to estimate the prevalence of LAAT in patients with AFL undergoing trans-esophageal echocardiography (TEE). Methods/results: We included 438 patients (404 with AF and 34 with AFL) scheduled for TEE to rule out LAAT before cardioversion (patients who reported no or inadequate anticoagulation before cardioversion). Demographic and echocardiographic data were compared between patients with and without LAAT. Despite a similar CHA2DS2-VASC score (3.8 ± 1.3 vs 3.4 ± 1.5 in the AF and AFL groups, respectively, P = .09), LAAT was documented in 12 (2.8%) in the AF group and in no patient in the AFL group (P < .0001). Conclusion: Based on our results and previous studies, it seems reasonable to re-evaluate the need for oral anticoagulation in specific populations with AFL such as those with solitary AFL (without a history of AF episodes) undergoing successful ablation and in those with low CHA2DS2-VASC score.

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心房扑动与心房颤动患者的左心房阑尾血栓风险

目的：心房颤动（房颤）患者发生血栓栓塞事件的风险增加，主要源于左心房阑尾血栓（LAAT）。心房扑动（AFL）患者的抗凝治疗标准与心房颤动患者相同。然而，心房扑动患者是否具有与心房颤动患者相似的血栓栓塞风险尚不清楚。本研究旨在估算接受经食道超声心动图（TEE）检查的 AFL 患者中 LAAT 的患病率。方法/结果：我们纳入了 438 名患者（404 名房颤患者和 34 名 AFL 患者），这些患者在心脏搭桥术前接受了 TEE 检查以排除 LAAT（患者在心脏搭桥术前未报告抗凝或抗凝不足）。对患有和未患有 LAAT 的患者的人口统计学和超声心动图数据进行了比较。尽管 CHA2DS2-VASC 评分相似（房颤组和 AFL 组分别为 3.8 ± 1.3 vs 3.4 ± 1.5，P = .09），但房颤组有 12 例（2.8%）患者记录到 LAAT，而 AFL 组无患者记录到 LAAT（P < .0001）。结论：根据我们的研究结果和之前的研究，重新评估特定 AFL 患者（如成功消融的单发 AFL 患者（无房颤发作史）和 CHA2DS2-VASC 评分较低的患者）口服抗凝药的必要性似乎是合理的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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