Thrombus im linken Vorhofohr: Prädisponierende Faktoren, Auflösungspotential und Einfluss auf die Prognose bei Patienten mit Vorhofflimmern im Versorgungsalltag.
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Philipps-Universität Marburg
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Abstract
The aim of our retrospective study of 7759 patients with symptomatic atrial fibrillation was to identify clinical, echocardiographic, and laboratory parameters that contribute to thrombus formation in the left atrial appendage. In the next step we tried to clarify the extent to which thrombus formation is reversible and whether this is a surrogate parameter for poor prognosis. 450 patients (5.8%) with LAA thrombus were identified. These patients were compared with a randomized control group of 481 patients without LAA thrombus. The primary therapeutic goals were to restore sinus rhythm using class I or III antiarrhythmic drugs (amiodarone), pulmonary vein isolation (PVI), and/or electrical cardioversion, and the resolution of LAA thrombus. Out of 450 patients with LAA thrombus, follow-up was not possible in 146 patients. In the remaining 304 patients, thrombus resolved in 56.3%.
Comparing both groups, patients with LAA thrombus showed significantly higher age, more strokes, higher rates of structural heart disease, higher CHA2DS2 -VASc scores, worse renal function, less well-controlled diabetes, more advanced heart failure, lower LAA emptying rates, and higher levels of cardiac and inflammatory markers (all p<0.001).
For the first time, thrombus resolution was shown to be associated with a significant increase in LAA flow velocities, suggesting LAA contractile reserve.
We also compared different success rates in restoring sinus rhythm. PVI or electrocardioversion alone and the combined strategy (PVI and eCV) were contrasted. With PVI alone, sinus rhythm was achieved in 95.6% of patients without LAA thrombi and in 66.6% of patients with resolved LAA thrombi (p < 0.001), similarly with eCV (93.2% versus 63.3%). In combination, sinus rhythm was restored in 83.6% of patients with resolved thrombi and in 98.2% of patients without thrombi (p < 0.001). With respect to long-term all-cause mortality, the presence of LAA thrombi was associated with a significantly lower 10-year survival (31%) as compared to patients without thrombi (69%).
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Created: 2023Issued: 2023-10-05Updated: 2023-10-05
Faculty
Medizin
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Philipps-Universität Marburg
Language
ger
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DoctoralThesis
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610
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Fuchs, Sophia: Thrombus im linken Vorhofohr: Prädisponierende Faktoren, Auflösungspotential und Einfluss auf die Prognose bei Patienten mit Vorhofflimmern im Versorgungsalltag.. : Philipps-Universität Marburg 2023-10-05. DOI: https://doi.org/10.17192/z2023.0549.