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Is Transesophageal Echocardiogram Mandatory for Patients Undergoing Ablation for Right Atrial Flutter with Uninterrupted Anticoagulants? A Prospective Single Registry.
  • +5
  • Anne Suzat,
  • ANTOINE DA COSTA,
  • Jean Baptiste Guichard,
  • Romain Pierrard,
  • Geoffrey Bayard,
  • Cedric Yvorel,
  • Karim Benali,
  • Karl Isaaz
Anne Suzat
Jean Monnet University Saint-Etienne University Institute of Technology
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ANTOINE DA COSTA
UNIVERSITY OF SAINT ETIENNE

Corresponding Author:[email protected]

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Jean Baptiste Guichard
Université Jean Monnet Saint-Etienne
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Romain Pierrard
Jean Monnet University Saint-Etienne University Institute of Technology
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Geoffrey Bayard
Jean Monnet University Saint-Etienne University Institute of Technology
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Cedric Yvorel
Jean Monnet University Saint-Etienne University Institute of Technology
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Karim Benali
Jean Monnet University Saint-Etienne University Institute of Technology
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Karl Isaaz
Saint-Etienne University Hospital Bellevue Site
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Abstract

Background. Limited data exist regarding left atrial appendage (LAA) thrombi and spontaneous echocardiographic contrast (SEC) in patients with atrial flutter (AFL). Objectives. We sought to evaluate the LAA thrombi prevalzence in AFL ablation patients compared to atrial fibrillation (AFib) ablation patients. Methods and Results. 321 consecutive patients referred for either AFib (n = 229) or AFL ablation (n = 92) were included with a thrombus detected by transesophageal echocardiography (TEE) in 3.22% (12/321). The percentage of thrombi was similar between AFL and AFib ablation patients (5.4% [n = 5/92] vs. 3.1% [n = 7/229]; p = 0.3). In the overall population, LAA thrombi patients had a higher CHA²DS²-VASc score (3 ± 2 vs. 2 ± 1.5; p = 0.048) and a higher presence of valvular prothesis (25% vs. 4.9%; p=0.003), with relevant left atrial remodeling such as demonstrated by a higher left atrium (LA) volume (57 ± 19 vs. 46 ± 17 ml/m²; p = 0.04) and a lower LAA velocity (0.41 ± 0.3 vs. 0.55 ± 0.2; p=0.04). In patients with right AFL, patients with LAA thrombi had a higher CHA²DS²-VASc score (4.4 ± 1 vs. 2.5 ± 1.5; p = 0.008), had more hypertension (100% vs. 53%; p = 0.04) and more diabetes mellitus (60% vs. 18.4%; p = 0.03), and a more severe LAA echo contrast (80% vs. 5.7%; p <0.0001). Conclusions. The risk of LAA thrombi is better related to the presence of valvular prosthesis, CHA²DS²-VASc score and LA remodelling than the atrial arrhythmia itself.