Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?
Corresponding Author
Avishag Laish-Farkash MD, PhD
Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
Correspondence
Avishag Laish-Farkash, MD, PhD, Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
Email: [email protected]
Search for more papers by this authorMahmoud Suleiman MD
Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
Search for more papers by this authorCorresponding Author
Avishag Laish-Farkash MD, PhD
Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
Correspondence
Avishag Laish-Farkash, MD, PhD, Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
Email: [email protected]
Search for more papers by this authorMahmoud Suleiman MD
Electrophysiology and Pacing Unit, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
Search for more papers by this authorDisclosures: None

REFERENCES
- 1Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm. 2012; 9: 632–696.
- 2Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37: 2893–2962.
- 3Heidbuchel H, Verhamme P, Alings M, et al. Updated European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015; 17: 1467–507.
- 4Calvo N, Mont L, Vidal B, et al. Usefulness of transoesophageal echocardiography before circumferential pulmonary vein ablation in patients with atrial fibrillation: Is it really mandatory? Europace. 2011; 13: 486–491.
- 5Scherr D, Sharma K, Dalal D, et al. Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2009; 20: 1357–1363.
- 6McCready JW, Nunn L, Lambiase PD, et al. Incidence of left atrial thrombus prior to atrial fibrillation ablation: Is pre-procedural transoesophageal echocardiography mandatory? Europace. 2010; 12: 927–932.
- 7Puwanant S, Varr BC, Shrestha K, et al. Role of the CHADS2 score in the evaluation of thromboembolic risk in patients with atrial fibrillation undergoing transesophageal echocardiography before pulmonary vein isolation. J Am Coll Cardiol. 2009; 54: 2032–2039.
- 8Sikorska A, Baran J, Pilichowska-Paszkiet E, et al. Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: Beyond the CHA2DS2VASc score. Pol Arch Med Wewn. 2015; 125: 921–928.
- 9Di Biase L, Burkhardt JD, Santangeli P, et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: Results from the role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) Randomized Trial. Circulation. 2014; 129: 2638–2644.
- 10Di Biase L, Lakkireddy D, Trivedi C, et al. Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: Results from a multicenter study. Heart Rhythm. 2015; 12: 1162–1168.
- 11Hohnloser SH, Camm AJ. Safety and efficacy of dabigatran etexilate during catheter ablation of atrial fibrillation: A meta-analysis of the literature. Europace. 2013; 15: 1407–1411.
- 12Lakkireddy D, Reddy YM, Di Biase L, et al. Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: Results from a multicenter prospective registry. J Am Coll Cardiol. 2014; 63: 982–988.
- 13Providencia R, Marijon E, Albenque JP, et al. Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation. Europace. 2014; 16: 1137–1144.
- 14Stepanyan G, Badhwar N, Lee RJ, et al. Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation. J Interv Card Electrophysiol. 2014; 40: 33–38.
- 15Aryal MR, Ukaigwe A, Pandit A, et al. Meta-analysis of efficacy and safety of rivaroxaban compared with warfarin or dabigatran in patients undergoing catheter ablation for atrial fibrillation. Am J Cardiol. 2014; 114: 577–582.
- 16Kaess BM, Ammar S, Reents T, et al. Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon. Am J Cardiol. 2015; 115: 47–51.
- 17Cappato R, Marchlinski FE, Hohnloser SH, et al; VENTURE-AF Investigators. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J. 2015; 36: 1805–1811.
- 18Calkins H, Willems S, Gerstenfeld EP, et al; RE-CIRCUIT Investigators. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med. 2017; 376: 1627–1636.
- 19Di Biase L, Callans D, Hæusler KG, et al. Rationale and design of AXAFA-AFNET 5: An investigator-initiated, randomized, open, blinded outcome assessment, multi-centre trial to comparing continuous apixaban to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation. Europace. 2017; 19: 132–138.
- 20Gunawardene MA, Dickow J, Schaeffer BN, et al. Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography. J Cardiovasc Electrophysiol. 2017; 28: https://doi.org/10.1111/jce.13279.
- 21Wyrembak J, Campbell KB, Steinberg BA, et al. Incidence and predictors of left atrial appendage thrombus in patients treated with nonvitamin K oral anticoagulants versus warfarin before catheter ablation for atrial fibrillation. Am J Cardiol. 2017; 119: 1017-1022.
- 22Reers S, Agdirlioglu T, Kellner M, et al. Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists. Eur J Med Res. 2016; 21: 41.
- 23Frenkel D, D'Amato SA, Al-Kazaz M, et al. Prevalence of left atrial thrombus detection by transesophageal echocardiography: A comparison of continuous non-vitamin K antagonist oral anticoagulant vs warfarin therapy in patients undergoing catheter ablation for atrial fibrillation. JACC Clin Electrophysiol. 2016. https://doi.org/10.1016/j.jacep.2016.01.004.
- 24Di Biase L, Briceno DF, Trivedi C, et al. Is transesophageal echocardiogram mandatory in patients undergoing ablation of atrial fibrillation with uninterrupted novel oral anticoagulants? Results from a prospective multicenter registry. Heart Rhythm. 2016; 13: 1197-1202.
- 25Dorenkamp M, Sohns C, Vollmann D, et al. Detection of left atrial thrombus during routine diagnostic work-up prior to pulmonary vein isolation for atrial fibrillation: Role of transesophageal echocardiography and multidetector computed tomography. Int J Cardiol. 2013; 163: 26–33.
- 26Zoppo F, Brandolino G, Berton A, et al. Predictors of left atrium appendage clot detection despite on-target warfarin prevention for atrial fibrillation. J Interv Card Electrophysiol. 2012; 35: 151–158
- 27Yamamoto M, Seo Y, Kawamatsu N, et al. Complex left atrial appendage morphology and left atrial appendage thrombus formation in patients with atrial fibrillation. Circ Cardiovasc Imaging. 2014; 7: 337–343.
- 28Akoum N, Fernandez G, Wilson B, McGann C, Kholmovski E, Marrouche N. Association of atrial fibrosis quantified using LGE-MRI with atrial appendage thrombus and spontaneous contrast on transesophageal echocardiography in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2013; 24: 1104–1109.
- 29Zuo K, Sun L, Yang X, Lyu X, Li K. Correlation between cardiac rhythm, left atrial appendage flow velocity, and CHA2 DS2 -VASc score: Study based on transesophageal echocardiography and 2-dimensional speckle tracking. Clin Cardiol. 2017; 40: 120–125.
- 30Clark CB, Telles Garcia NA, Hackett Renner C, Ryan SM. Correlation of left atrial appendage ejection velocities with the CHADS2 and CHA2DS2-VASc scores. Echocardiography. 2016; 33: 1195–201.
- 31Doukky R, Garcia-Sayan E, Gage H, et al. The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Cardiovasc Ultrasound. 2014; 12: 10.