Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study
MF Stoddard,
PR Dawkins,
CR Prince,
and
NM Ammash
Department of Medicine, University of Louisville, Kentucky 40202.
OBJECTIVES. The objective of this study was to determine the frequency of left atrial thrombus in patients with acute atrial fibrillation. BACKGROUND. It is commonly assumed but unproved that left atrial thrombus in patients with atrial fibrillation begins to form after the onset of atrial fibrillation and that it requires > or = 3 days to form. Thus, patients with acute atrial fibrillation (i.e., < 3 days) frequently undergo cardioversion without anticoagulation prophylaxis. METHODS. Three hundred seventeen patients (250 men, 67 women; mean [+/- SD] age 64 +/- 12 years) with acute (n = 143) or chronic (n = 174) atrial fibrillation were studied by two-dimensional transesophageal echocardiography. RESULTS. Left atrial appendage thrombus was present in 20 patients (14%) with acute and 47 patients (27%, p < 0.01) with chronic atrial fibrillation. In patients with a recent embolic event, the frequency of left atrial appendage thrombus did not differ between those with acute (5 [21%] of 24) and those with chronic (12 [23%] of 52, p = NS) atrial fibrillation. Patients with acute versus chronic atrial fibrillation, respectively, did not differ (p = NS) in mean age (64 +/- 13 vs. 65 +/- 11 years), frequency of concentric left ventricular hypertrophy (32% vs. 26%), hypertension (32% vs. 41%), coronary artery disease (35% vs. 39%), congestive heart failure (43% vs. 48%), mitral stenosis (4% vs. 7%) or mitral valve replacement (1.4% vs. 6%). The minimally detectable difference in proportions between patients with acute and chronic atrial fibrillation based on a power of 0.80 and base proportion of 0.20 was 14%. CONCLUSIONS. Left atrial thrombus does occur in patients with acute atrial fibrillation < 3 days in duration. The frequency of left atrial thrombus in patients with recent emboli is comparable between those with acute and chronic atrial fibrillation. These data suggest that patients with acute atrial fibrillation for < 3 days require anticoagulation prophylaxis or evaluation by transesophageal echocardiography before cardioversion and should not be assumed to be free of left atrial thrombus.
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|
 
C. W. Khoo and G. Y. H. Lip
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Chest,
March 1, 2009;
135(3):
849 - 859.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. H. Tayal, M. Tian, K. M. Kelly, S. C. Jones, D. G. Wright, D. Singh, J. Jarouse, J. Brillman, S. Murali, and R. Gupta
Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke
Neurology,
November 18, 2008;
71(21):
1696 - 1701.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Singer, G. W. Albers, J. E. Dalen, M. C. Fang, A. S. Go, J. L. Halperin, G. Y. H. Lip, and W. J. Manning
Antithrombotic Therapy in Atrial Fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest,
June 1, 2008;
133(6_suppl):
546S - 592S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Body and B. Allie
Negative D-dimer may allow safe early cardioversion of atrial fibrillation
Emerg. Med. J.,
June 1, 2007;
24(6):
432 - 435.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. C. Block
Watching the Watchman
J. Am. Coll. Cardiol.,
April 3, 2007;
49(13):
1496 - 1497.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. B. Sick, G. Schuler, K. E. Hauptmann, E. Grube, S. Yakubov, Z. G. Turi, G. Mishkel, S. Almany, and D. R. Holmes
Initial Worldwide Experience With the WATCHMAN Left Atrial Appendage System for Stroke Prevention in Atrial Fibrillation
J. Am. Coll. Cardiol.,
April 3, 2007;
49(13):
1490 - 1495.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C J Mann, S Kendall, G Y H Lip, and on behalf of the Guideline Development Group for t
Acute management of atrial fibrillation with acute haemodynamic instability and in the postoperative setting
Heart,
January 1, 2007;
93(1):
45 - 47.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
651 - 745.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
854 - 906.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
e149 - e246.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation,
August 15, 2006;
114(7):
e257 - e354.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation,
August 15, 2006;
114(7):
700 - 752.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Eur. Heart J.,
August 2, 2006;
27(16):
1979 - 2030.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kollar, S. D. Lick, K. N. Vasquez, and V. R. Conti
Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?
Ann. Thorac. Surg.,
August 1, 2006;
82(2):
515 - 523.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. H. Ostermayer, M. Reisman, P. H. Kramer, R. V. Matthews, W. A. Gray, P. C. Block, H. Omran, A. L. Bartorelli, P. Della Bella, C. Di Mario, et al.
Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO System) to Prevent Stroke in High-Risk Patients With Non-Rheumatic Atrial Fibrillation: Results From the International Multi-Center Feasibility Trials
J. Am. Coll. Cardiol.,
July 5, 2005;
46(1):
9 - 14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.P. Kuhl and P. Hanrath
The impact of transesophageal echocardiography on daily clinical practice
Eur J Echocardiogr,
December 1, 2004;
5(6):
455 - 468.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Marin, V Roldan, V E Climent, A Ibanez, A Garcia, P Marco, F Sogorb, and G Y H Lip
Plasma von Willebrand factor, soluble thrombomodulin, and fibrin D-dimer concentrations in acute onset non-rheumatic atrial fibrillation
Heart,
October 1, 2004;
90(10):
1162 - 1166.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Wakai and J O O'Neill
Emergency management of atrial fibrillation
Postgrad. Med. J.,
June 1, 2003;
79(932):
313 - 319.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Gentile, A. Elhendy, B. K. Khandheria, J. B. Seward, C. M. Lohse, W.-K. Shen, K. R. Bailey, S. C. Montgomery, K. N. Burger, and A. J. Tajik
Safety of Electrical Cardioversion in Patients With Atrial Fibrillation
Mayo Clin. Proc.,
September 1, 2002;
77(9):
897 - 904.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. Williams, M. Ansari, and G.Y.H. Lip
Managing atrial fibrillation in the Accident and Emergency department
QJM,
November 1, 2001;
94(11):
609 - 614.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Shi, A. Ducharme, D. Li, R. Gaspo, S. Nattel, and J.-C. Tardif
Remodeling of atrial dimensions and emptying function in canine models of atrial fibrillation
Cardiovasc Res,
November 1, 2001;
52(2):
217 - 225.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
Circulation,
October 23, 2001;
104(17):
2118 - 2150.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology
Eur. Heart J.,
October 2, 2001;
22(20):
1852 - 1923.
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
J. Am. Coll. Cardiol.,
October 1, 2001;
38(4):
1231 - 1265.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
J. Am. Coll. Cardiol.,
October 1, 2001;
38(4):
1266 - 1266.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. El Gendi, B. Wasan, J. Mayet, D. M. Gilligan, and R. H. Falk
Atrial Fibrillation
N. Engl. J. Med.,
August 23, 2001;
345(8):
620 - 621.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kamath and G.Y.H. Lip
Cardioversion of atrial fibrillation or flutter: a 'stunning' problem
Eur. Heart J.,
March 2, 2001;
22(6):
520 - 521.
[PDF]
|
|
|
|
|
|
|
A. L. Klein, R. D. Murray, and R. A. Grimm
Role of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation
J. Am. Coll. Cardiol.,
March 1, 2001;
37(3):
691 - 704.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Albers, J. E. Dalen, A. Laupacis, W. J. Manning, P. Petersen, and D. E. Singer
Antithrombotic Therapy in Atrial Fibrillation
Chest,
January 1, 2001;
119
(2009):
194S - 206S.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Stellbrink and P. Hanrath
The optimal management of cardioversion of atrial fibrillation of flutter: still a 'stunning' problem
Eur. Heart J.,
May 2, 2000;
21(10):
795 - 798.
[PDF]
|
|
|
|
|
|
|
A.U Khand, A.C Rankin, G.C Kaye, and J.G.F Cleland
Systematic review of the management of atrial fibrillation in patients with heart failure
Eur. Heart J.,
April 2, 2000;
21(8):
614 - 632.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. W. Hogue Jr and M. L. Hyder
Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment
Ann. Thorac. Surg.,
January 1, 2000;
69(1):
300 - 306.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Lancaster, J. Mayet, B. Wasan, P. Kanagaratnam, K M English, and K S Channer
Managing atrial fibrillation in elderly people
BMJ,
August 14, 1999;
319(7207):
452a - 452.
[Full Text]
|
|
|
|
|
|
|
P. B. Sparks, S. Jayaprakash, H. G. Mond, J. K. Vohra, L. E. Grigg, and J. M. Kalman
Left atrial mechanical function after brief duration atrial fibrillation
J. Am. Coll. Cardiol.,
February 1, 1999;
33(2):
342 - 349.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M C Hardman and M. R Cowie
Fortnightly review: Anticoagulation in heart disease
BMJ,
January 23, 1999;
318(7178):
238 - 244.
[Full Text]
|
|
|
|
|
|
|
D. I. Silverman and W. J. Manning
Role of Echocardiography in Patients Undergoing Elective Cardioversion of Atrial Fibrillation
Circulation,
August 4, 1998;
98(5):
479 - 486.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Eldar, M. Canetti, Z. Rotstein, V. Boyko, S. Gottlieb, E. Kaplinsky, and S. Behar
Significance of Paroxysmal Atrial Fibrillation Complicating Acute Myocardial Infarction in the Thrombolytic Era
Circulation,
March 17, 1998;
97(10):
965 - 970.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Minamino, M. Kitakaze, H. Sato, H. Asanuma, H. Funaya, Y. Koretsune, and M. Hori
Plasma Levels of Nitrite/Nitrate and Platelet cGMP Levels Are Decreased in Patients With Atrial Fibrillation
Arterioscler Thromb Vasc Biol,
November 1, 1997;
17(11):
3191 - 3195.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
S. R. Ommen, J. A. Odell, and M. S. Stanton
Atrial Arrhythmias after Cardiothoracic Surgery
N. Engl. J. Med.,
May 15, 1997;
336(20):
1429 - 1434.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Oltrona, M. Broccolino, P. A. Merlini, A. Spinola, A. Pezzano, and P. M. Mannucci
Activation of the Hemostatic Mechanism After Pharmacological Cardioversion of Acute Nonvalvular Atrial Fibrillation
Circulation,
April 15, 1997;
95(8):
2003 - 2006.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al.
ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography
Circulation,
March 18, 1997;
95(6):
1686 - 1744.
[Full Text]
|
|
|
|
|
|
|
J. R. Schlicht, K. Naqi, W. Cooper, and B. V. Rao
Anticoagulation for Cardioversion of Atrial Fibrillation-Reply
Arch Intern Med,
September 9, 1996;
156(16):
1894 - 1895.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. N. Prystowsky, D. W. Benson Jr, V. Fuster, R. G. Hart, G. N. Kay, R. J. Myerburg, G. V. Naccarelli, and D. G. Wyse
Management of Patients With Atrial Fibrillation : A Statement for Healthcare Professionals From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association
Circulation,
March 15, 1996;
93(6):
1262 - 1277.
[Full Text]
|
|
|
|
|
|
|
B. D. Lindsay
Obliteration of the Left Atrial Appendage: A Concept Worth Testing
Ann. Thorac. Surg.,
February 1, 1996;
61(2):
515 - 515.
[Full Text]
|
|
|
|
|
|
|
J. L. Blackshear and J. A. Odell
Appendage Obliteration to Reduce Stroke in Cardiac Surgical Patients With Atrial Fibrillation
Ann. Thorac. Surg.,
February 1, 1996;
61(2):
755 - 759.
[Abstract]
[Full Text]
|
|
|
|
