Yang Zhan1, Jacqueline Joza2, Mohamed Al Rawahi3, Rodrigo S Barbosa4, Michelle Samuel5, Martin Bernier2, Thao Huynh2, George Thanassoulis2, Vidal Essebag6. 1. McGill University Health Centre, Montreal, Quebec, Canada. 2. McGill University Health Centre, Montreal, Quebec, Canada; Research Institute of McGill University Health Centre, Montreal, Quebec, Canada. 3. McGill University Health Centre, Montreal, Quebec, Canada; University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. McGill University Health Centre, Montreal, Quebec, Canada; Hospital Albert Sabin, Juiz de Fora, Minas Gerais, Brazil. 5. Research Institute of McGill University Health Centre, Montreal, Quebec, Canada. 6. McGill University Health Centre, Montreal, Quebec, Canada; Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada. Electronic address: vidal.essebag@mcgill.ca.
Abstract
BACKGROUND: Intracardiac thrombi arising in the left atrial appendage (LAA) are the principal cause of stroke in nonvalvular atrial fibrillation (AF). Predicting the presence of LAA thrombi is of vital importance in stratifying patients that would need further LAA imaging prior to cardioversion or AF ablation. METHODS: We comprehensively searched PubMed from its inception to November 2017 for randomized controlled trials, cohort and case control studies, as well as for case series on LAA thrombi risk factors, imaging, prevention, and anticoagulation management in atrial fibrillation. RESULTS: A systematic review of the literature identified 106 articles that investigated the presence of LAA thrombi in AF patients. We classified the articles according to topic and reported on: (1) risk factors; (2) diagnostic imaging modalities; (3) prevention strategies before cardioversion; (4) prevention strategies before AF ablation; and (5) management of detected LAA thrombi. CONCLUSIONS: Integration of clinical, biomarker, and imaging risk factors can improve overall prediction for the presence of LAA thrombi, translating into improved patient selection for imaging. The gold standard for the diagnosis of LAA thrombi remains transesophageal echocardiography, although intracardiac ultrasound, cardiac computed tomography, and cardiovascular magnetic imaging are promising alternative modalities. When LAA thrombi are discovered, the treatment regimen remains variable, although direct oral anticoagulants might have efficacy similar to vitamin K antagonists. Future trials will help further elucidate direct oral anticoagulant use for the treatment of LAA thrombi.
BACKGROUND: Intracardiac thrombi arising in the left atrial appendage (LAA) are the principal cause of stroke in nonvalvular atrial fibrillation (AF). Predicting the presence of LAA thrombi is of vital importance in stratifying patients that would need further LAA imaging prior to cardioversion or AF ablation. METHODS: We comprehensively searched PubMed from its inception to November 2017 for randomized controlled trials, cohort and case control studies, as well as for case series on LAA thrombi risk factors, imaging, prevention, and anticoagulation management in atrial fibrillation. RESULTS: A systematic review of the literature identified 106 articles that investigated the presence of LAA thrombi in AFpatients. We classified the articles according to topic and reported on: (1) risk factors; (2) diagnostic imaging modalities; (3) prevention strategies before cardioversion; (4) prevention strategies before AF ablation; and (5) management of detected LAA thrombi. CONCLUSIONS: Integration of clinical, biomarker, and imaging risk factors can improve overall prediction for the presence of LAA thrombi, translating into improved patient selection for imaging. The gold standard for the diagnosis of LAA thrombi remains transesophageal echocardiography, although intracardiac ultrasound, cardiac computed tomography, and cardiovascular magnetic imaging are promising alternative modalities. When LAA thrombi are discovered, the treatment regimen remains variable, although direct oral anticoagulants might have efficacy similar to vitamin K antagonists. Future trials will help further elucidate direct oral anticoagulant use for the treatment of LAA thrombi.
Authors: Sebastian Feickert; Giuseppe D Ancona; Hüseyin Ince; Kristof Graf; Elias Kugel; Monica Murero; Erdal Safak Journal: J Atr Fibrillation Date: 2020-10-31
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Authors: Claudio A Bravo; Justin A Fried; Joshua Z Willey; Azka Javaid; Giulio M Mondellini; Lorenzo Braghieri; Heidi Lumish; Veli K Topkara; Yuji Kaku; Lucas Witer; Hiroo Takayama; Koji Takeda; Gabriel Sayer; Nir Uriel; Ryan T Demmer; Yoshifumi Naka; Melana Yuzefpolskaya; Paolo C Colombo Journal: J Card Fail Date: 2021-06-20 Impact factor: 5.712
Authors: Mohamed Al Rawahi; Michelle Samuel; Christos Galatas; Jacqueline Joza; Pedro Y Lima; Rodrigo Barbosa; George Thanassoulis; Martin L Bernier; Thao Huynh; Vidal Essebag Journal: CJC Open Date: 2019-07-02