Percutaneous left atrial appendage occlusion (LAAO) is contraindicated in presence of left atrial appendage (LAA) thrombus. It is often difficult to separate LAA sludge from an organized thrombus on transesophageal echocardiography. The inability to differentiate sludge from thrombus leads to patients not receiving LAAO despite contraindication to long-term anticoagulation. Retrospective 6-month follow-up outcomes are reported on patients undergoing LAAO in presence of LAA sludge cleared by isoproterenol. This study showed no increased risk of transient ischemic attack/stroke in the 6 months following LAAO in the presence of LAA sludge, which was cleared with isoproterenol. This study suggests a role for isoproterenol in differentiating sludge from thrombus.
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| http://dx.doi.org/10.1016/j.jacep.2022.10.026 | DOI Listing |
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Transesophageal echocardiography (TEE) is the standard method for diagnosing left atrial appendage (LAA) hypercoagulability in patients with atrial fibrillation (AF), which means LAA thrombus/sludge, dense spontaneous echo contrast and slow LAA blood flow velocity (< 0.25 m/s). Based on machine learning algorithms, cardiac computed tomography angiography (CCTA) radiomics features were adopted to construct prediction models and explore a suitable approach for diagnosing LAA hypercoagulability and adjusting anticoagulation.
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- * The study involved 46 patients over 2 years, comparing outcomes based on whether they had CA before or after LAAC, with a focus on complications and adverse events.
- * Results showed that CA post-LAAC was safe, with no device-related issues reported even in the early phase after LAAC, while a few complications occurred when LAAC was done after CA.
Morphology and location of thrombus and sludge in patients with non-valvular atrial fibrillation.
BMC Cardiovasc Disord
July 2024
Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China.
Background: Stroke and thromboembolism in nonvalvular atrial fibrillation (NVAF) primarily arise from thrombi or sludge in the left atrial appendage (LAA). Comprehensive insight into the characteristics of these formations is essential for effective risk assessment and management.
Methods: We conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019.
Risk factors for thrombosis and spontaneous echocardiographic contrast with sludge in atrial fibrillation patients treated with oral anticoagulants before electrical cardioversion.
Kardiol Pol
June 2024
Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland.
Background: Knowledge of thrombosis (T) risk predictors and transesophageal echocardiography (TEE) are important tools in appropriate qualification of patients for safe electrical cardioversion.
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