Scherr Daniel, Dalal Darshan, Chilukuri Karuna, Dong Jun, Spragg David, Henrikson Charles A, Nazarian Saman, Cheng Alan, Berger Ronald D, Abraham Theodore P, Calkins Hugh, Marine Joseph E
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
J Cardiovasc Electrophysiol. 2009 Apr;20(4):379-84. doi: 10.1111/j.1540-8167.2008.01336.x. Epub 2008 Oct 27.
Transesophageal echocardiography (TEE) is commonly used prior to catheter ablation of atrial fibrillation (AF) in order to exclude left atrial (LA) thrombus. However, the incidence and predictors of LA thrombus detected with TEE have not been systematically examined in this setting.
This study included 732 cases (mean age 57 +/- 11 years; 23% female; 353 persistent AF) in 585 consecutive patients referred for catheter ablation of AF. Patients were anticoagulated for at least 4 weeks prior to the procedure and then bridged with enoxaparin. TEE was performed in all cases within 24 hours prior to ablation.
Preprocedural TEE revealed LA thrombus in 12 of 732 cases (1.6%), all located in the LA appendage. Among these 12 patients, 9 had persistent AF and 3 had paroxysmal AF. All patients with thrombus had an LA size >or= 4.5 cm. LA thrombus was present in 0.3%, 1.4%, and 5.3% of patients with CHADS(2) scores of 0, 1, and >or= 2, respectively. In multivariate analysis, a CHADS(2) score >or= 2 and larger LA diameter remained significant predictors of LA thrombus.
Despite oral anticoagulation treatment, there is a small but significant incidence of LA thrombus by TEE prior to AF ablation. A CHADS(2) score >or= 2 and larger LA diameter are independent predictors of LA thrombus in this patient population, while type of AF or rhythm at the time of TEE is not. The risk of LA thrombus is low in patients with a CHADS(2) score of 0 and in patients with an LA diameter < 4.5 cm.
经食管超声心动图（TEE）常用于心房颤动（AF）导管消融术前以排除左心房（LA）血栓形成。然而，在此背景下，经TEE检测到的LA血栓形成的发生率及预测因素尚未得到系统研究。
本研究纳入了585例连续接受AF导管消融术患者中的732例（平均年龄57±11岁；23%为女性；353例为持续性AF）。患者在手术前至少抗凝4周，然后采用依诺肝素进行桥接抗凝。所有病例在消融术前24小时内均进行了TEE检查。
术前TEE在732例病例中发现12例（1.6%）存在LA血栓，均位于左心耳。在这12例患者中，9例为持续性AF，3例为阵发性AF。所有有血栓的患者左心房大小均≥4.5 cm。CHADS(2)评分为0、1和≥2的患者中，LA血栓形成的发生率分别为0.3%、1.4%和5.3%。多因素分析显示，CHADS(2)评分≥2和左心房直径较大仍是LA血栓形成的显著预测因素。
尽管进行了口服抗凝治疗，但在AF消融术前经TEE检查发现LA血栓形成的发生率虽低但仍具有统计学意义。在该患者群体中，CHADS(2)评分≥2和左心房直径较大是LA血栓形成的独立预测因素，而TEE检查时AF的类型或心律则不是。CHADS(2)评分为0的患者以及左心房直径<4.5 cm的患者发生LA血栓形成的风险较低。
