Left atrial thrombus and dense spontaneous echocardiographic contrast in patients on continuous direct oral anticoagulant therapy undergoing catheter ablation of atrial fibrillation: Comparison of dabigatran, rivaroxaban, and apixaban
Left atrial thrombus (LAT) and dense spontaneous echocardiographic contrast (SEC) detected by transesophageal echocardiography (TEE) in patients on continuous direct oral anticoagulants (DOAC) therapy before catheter ablation of atrial fibrillation (AF) or atrial flutter (AFL) have been described. W...
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| Published in | Heart rhythm Vol. 15; no. 4; pp. 496 - 502 |
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| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.04.2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1547-5271 1556-3871 1556-3871 |
| DOI | 10.1016/j.hrthm.2017.12.005 |
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| Abstract | Left atrial thrombus (LAT) and dense spontaneous echocardiographic contrast (SEC) detected by transesophageal echocardiography (TEE) in patients on continuous direct oral anticoagulants (DOAC) therapy before catheter ablation of atrial fibrillation (AF) or atrial flutter (AFL) have been described.
We sought to compare rates of TEE-detected LAT and dense SEC among patients taking different DOACs.
We evaluated 609 consecutive patients from 3 tertiary hospitals (median age 65 years; interquartile range 58–71 years; 436 (72%) men) who were on ≥4 weeks of continuous DOAC therapy (dabigatran, n = 166 [27%]; rivaroxaban, n = 257 [42%]; or apixaban, n = 186 [31%]) undergoing TEE before catheter ablation of AF/AFL. Demographic, clinical, and TEE data were collected for each patient.
Despite ≥4 weeks of continuous DOAC therapy, 17 patients (2.8%) had LAT and 15 patients (2.5%) had dense SEC detected by TEE. The rates of LAT were 3.0%, 3.5%, and 1.6% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .482). The rates of dense SEC were 1.2%, 3.5%, and 2.2% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .299). Congestive heart failure (odds ratio 4.4; 95% confidence interval 1.6–12; P = .003) and moderate/severe left atrial enlargement (odds ratio 3.1; 95% confidence interval 1.1–8.6; P = .026) were independent predictors of LAT.
In this study, ∼3% of patients on continuous DOAC therapy had LAT detected before catheter ablation of AF/AFL. Specific DOAC therapy did not significantly affect the rates of LAT detection. |
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| AbstractList | Left atrial thrombus (LAT) and dense spontaneous echocardiographic contrast (SEC) detected by transesophageal echocardiography (TEE) in patients on continuous direct oral anticoagulants (DOAC) therapy before catheter ablation of atrial fibrillation (AF) or atrial flutter (AFL) have been described.BACKGROUNDLeft atrial thrombus (LAT) and dense spontaneous echocardiographic contrast (SEC) detected by transesophageal echocardiography (TEE) in patients on continuous direct oral anticoagulants (DOAC) therapy before catheter ablation of atrial fibrillation (AF) or atrial flutter (AFL) have been described.We sought to compare rates of TEE-detected LAT and dense SEC among patients taking different DOACs.OBJECTIVEWe sought to compare rates of TEE-detected LAT and dense SEC among patients taking different DOACs.We evaluated 609 consecutive patients from 3 tertiary hospitals (median age 65 years; interquartile range 58-71 years; 436 (72%) men) who were on ≥4 weeks of continuous DOAC therapy (dabigatran, n = 166 [27%]; rivaroxaban, n = 257 [42%]; or apixaban, n = 186 [31%]) undergoing TEE before catheter ablation of AF/AFL. Demographic, clinical, and TEE data were collected for each patient.METHODSWe evaluated 609 consecutive patients from 3 tertiary hospitals (median age 65 years; interquartile range 58-71 years; 436 (72%) men) who were on ≥4 weeks of continuous DOAC therapy (dabigatran, n = 166 [27%]; rivaroxaban, n = 257 [42%]; or apixaban, n = 186 [31%]) undergoing TEE before catheter ablation of AF/AFL. Demographic, clinical, and TEE data were collected for each patient.Despite ≥4 weeks of continuous DOAC therapy, 17 patients (2.8%) had LAT and 15 patients (2.5%) had dense SEC detected by TEE. The rates of LAT were 3.0%, 3.5%, and 1.6% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .482). The rates of dense SEC were 1.2%, 3.5%, and 2.2% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .299). Congestive heart failure (odds ratio 4.4; 95% confidence interval 1.6-12; P = .003) and moderate/severe left atrial enlargement (odds ratio 3.1; 95% confidence interval 1.1-8.6; P = .026) were independent predictors of LAT.RESULTSDespite ≥4 weeks of continuous DOAC therapy, 17 patients (2.8%) had LAT and 15 patients (2.5%) had dense SEC detected by TEE. The rates of LAT were 3.0%, 3.5%, and 1.6% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .482). The rates of dense SEC were 1.2%, 3.5%, and 2.2% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .299). Congestive heart failure (odds ratio 4.4; 95% confidence interval 1.6-12; P = .003) and moderate/severe left atrial enlargement (odds ratio 3.1; 95% confidence interval 1.1-8.6; P = .026) were independent predictors of LAT.In this study, ∼3% of patients on continuous DOAC therapy had LAT detected before catheter ablation of AF/AFL. Specific DOAC therapy did not significantly affect the rates of LAT detection.CONCLUSIONIn this study, ∼3% of patients on continuous DOAC therapy had LAT detected before catheter ablation of AF/AFL. Specific DOAC therapy did not significantly affect the rates of LAT detection. Left atrial thrombus (LAT) and dense spontaneous echocardiographic contrast (SEC) detected by transesophageal echocardiography (TEE) in patients on continuous direct oral anticoagulants (DOAC) therapy before catheter ablation of atrial fibrillation (AF) or atrial flutter (AFL) have been described. We sought to compare rates of TEE-detected LAT and dense SEC among patients taking different DOACs. We evaluated 609 consecutive patients from 3 tertiary hospitals (median age 65 years; interquartile range 58-71 years; 436 (72%) men) who were on ≥4 weeks of continuous DOAC therapy (dabigatran, n = 166 [27%]; rivaroxaban, n = 257 [42%]; or apixaban, n = 186 [31%]) undergoing TEE before catheter ablation of AF/AFL. Demographic, clinical, and TEE data were collected for each patient. Despite ≥4 weeks of continuous DOAC therapy, 17 patients (2.8%) had LAT and 15 patients (2.5%) had dense SEC detected by TEE. The rates of LAT were 3.0%, 3.5%, and 1.6% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .482). The rates of dense SEC were 1.2%, 3.5%, and 2.2% for patients on dabigatran, rivaroxaban, and apixaban, respectively (P = .299). Congestive heart failure (odds ratio 4.4; 95% confidence interval 1.6-12; P = .003) and moderate/severe left atrial enlargement (odds ratio 3.1; 95% confidence interval 1.1-8.6; P = .026) were independent predictors of LAT. In this study, ∼3% of patients on continuous DOAC therapy had LAT detected before catheter ablation of AF/AFL. Specific DOAC therapy did not significantly affect the rates of LAT detection. |
| Author | Markowitz, Steven M. Gabriels, James Patel, Apoor Shaban, Nada Thomas, George Liu, Christopher F. Singh, Parmanand Wu, Michael D'Amato, Salvatore Khan, Mohammad Ip, James E. Cheung, Jim W. Lerman, Bruce |
| Author_xml | – sequence: 1 givenname: Michael surname: Wu fullname: Wu, Michael organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 2 givenname: James orcidid: 0000-0002-1095-6626 surname: Gabriels fullname: Gabriels, James organization: Department of Cardiology, North Shore University Hospital – Hofstra Northwell Health System, Manhasset, New York – sequence: 3 givenname: Mohammad surname: Khan fullname: Khan, Mohammad organization: Department of Cardiology, North Shore University Hospital – Hofstra Northwell Health System, Manhasset, New York – sequence: 4 givenname: Nada surname: Shaban fullname: Shaban, Nada organization: Department of Cardiology, North Shore University Hospital – Hofstra Northwell Health System, Manhasset, New York – sequence: 5 givenname: Salvatore surname: D'Amato fullname: D'Amato, Salvatore organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 6 givenname: Christopher F. surname: Liu fullname: Liu, Christopher F. organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 7 givenname: Steven M. surname: Markowitz fullname: Markowitz, Steven M. organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 8 givenname: James E. surname: Ip fullname: Ip, James E. organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 9 givenname: George surname: Thomas fullname: Thomas, George organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 10 givenname: Parmanand surname: Singh fullname: Singh, Parmanand organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 11 givenname: Bruce surname: Lerman fullname: Lerman, Bruce organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York – sequence: 12 givenname: Apoor surname: Patel fullname: Patel, Apoor organization: Department of Cardiology, North Shore University Hospital – Hofstra Northwell Health System, Manhasset, New York – sequence: 13 givenname: Jim W. surname: Cheung fullname: Cheung, Jim W. email: jac9029@med.cornell.edu organization: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital-Weill Cornell Medicine, New York, New York |
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| Keywords | Direct oral anticoagulant Left atrial thrombus Atrial fibrillation Catheter ablation Dense spontaneous echo contrast Atrial flutter |
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| SubjectTerms | Atrial fibrillation Atrial flutter Catheter ablation Dense spontaneous echo contrast Direct oral anticoagulant Left atrial thrombus |
| Title | Left atrial thrombus and dense spontaneous echocardiographic contrast in patients on continuous direct oral anticoagulant therapy undergoing catheter ablation of atrial fibrillation: Comparison of dabigatran, rivaroxaban, and apixaban |
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