The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Department of Cardiology, Nanyang Central Hospital, Nanyang, China.
BMC Cardiovasc Disord. 2023 Jan 17;23(1):28. doi: 10.1186/s12872-023-03050-z.
Atrial fibrillation (AF) predisposes patients to the formation of atrial thrombi. The CHADS-VASc score does not include all risk factors for atrial thrombosis. The present study is designed to explore the influencing factors of thrombus formation in patients with AF and to investigate the effect of catheter ablation (CA) on recurrent thrombosis in patients with a history of intracardiac thrombus.
(1) This study consisted of 1726 patients that underwent CA, among which 58 patients had a history of intracardiac thrombus prior to CA. The risk factors for thrombus formation were explored by comparing the baseline clinical characteristics of patients with and without atrial thrombus. (2) The left atrial appendage flow velocity (LAAFV) in patients with a history of intracardiac thrombus who were willing to undergo transesophageal echocardiography (TEE) at the latest follow-up were examined, and comparisons of the LAAFV was made before and after CA.
The median follow-up period is 13 months. Persistent AF was found to be the only independent risk factor affecting the formation of atrial thrombus among the investigated factors (OR 3.152; 95%CI 1.806-5.500; p < 0.001). Twenty-seven patients agreed to undergo TEE during follow-up, no clinical ischemic stroke events were recorded, no recurrent intracardiac thrombus formation was detected in patients, 15 patients maintained sinus rhythm (55.6%) during follow-up; successful CA significantly increased LAAFV (difference between latest evaluation prior to CA 17.46 ± 14.81 cm/s, p < 0.001).
Persistent AF is the only independent risk factor for thrombus formation. Successful CA may improve the LAAFV and thereby decrease the risk of intracardiac thrombus formation.
心房颤动（AF）使患者容易形成心房血栓。CHADS-VASc 评分并未包含所有导致心房血栓的危险因素。本研究旨在探讨 AF 患者血栓形成的影响因素，并研究导管消融（CA）对既往有心脏内血栓史患者复发性血栓形成的影响。
（1）本研究纳入了 1726 例行 CA 的患者，其中 58 例患者在 CA 前有心脏内血栓史。通过比较有和无心房血栓患者的基线临床特征，探讨血栓形成的危险因素。（2）对愿意在最新随访时行经食管超声心动图（TEE）检查的既往有心脏内血栓史患者的左心耳血流速度（LAAFV）进行检测，并比较 CA 前后的 LAAFV。
中位随访时间为 13 个月。持续性 AF 是唯一影响心房血栓形成的独立危险因素（OR 3.152；95%CI 1.806-5.500；p<0.001）。27 例患者在随访期间同意行 TEE，未记录到临床缺血性脑卒中事件，未发现患者有复发性心脏内血栓形成，15 例患者在随访期间维持窦性心律（55.6%）；成功的 CA 显著增加了 LAAFV（CA 前最新评估时的差值为 17.46±14.81 cm/s，p<0.001）。
持续性 AF 是血栓形成的唯一独立危险因素。成功的 CA 可能会改善 LAAFV，从而降低心脏内血栓形成的风险。
