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International Journal of
Clinical Cardiology ISSN: 2378-2951

Citation

Grebmer C, Lennerz C, Brkic A, Blazek P, Weigand S, et al. (2019) Prevalence and Clinical Correlates of Spontaneous Echo Contrast in Patients on Oral Anticoagulation Undergoing Catheter Ablation for Atrial Fibrillation. Int J Clin Cardiol 6:151. doi.org/10.23937/2378-2951/1410151

Copyright

© 2019 Grebmer C. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESSDOI: 10.23937/2378-2951/1410151

Prevalence and Clinical Correlates of Spontaneous Echo Contrast in Patients on Oral Anticoagulation Undergoing Catheter Ablation for Atrial Fibrillation

Christian Grebmer1*, Carsten Lennerz1,2, Amir Brkic1, Patrick Blazek1, Severin Weigand1,2, Verena Semmler1, Marc Kottmaier1, Felix Bourier1, Lena Friedrich1, Elena Risse1, Stephanie Brooks1, Marie Kornmayer1, Marta Telishevska1, Tilko Reents1, Christof Kolb1,2, Gabriele Hessling1,2 and Isabel Deisenhofer1,2

1Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany

2DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany

Abstract

Background

Spontaneous echo contrast (SEC) in the left atrial appendage (LAA) is associated with an increased risk of cerebral embolism in patients with atrial fibrillation (AF). Novel oral anticoagulants (NOACs) are increasingly prescribed as first-line therapy and have shown a comparable benefit-risk ratio compared to vitamin K antagonists (VKAs). The aim of this study was to investigate whether NOACs decrease the incidence of SEC compared to VKA.

Methods

We retrospectively analysed 542 patients who underwent transoesophageal echocardiography (TEE) prior to AF ablation at our institution. SEC was characterised by dynamic, smoke-like echoes within the LA cavity or LAA on TEE.

Results

SEC was detected in 58 patients (10.7%) and occurred significantly more often in patients on VKA (n = 39; 13.6%) compared to patients on NOACs (n = 19, 7.5%; p = 0.02). Decreased left ventricular function (p < 0.001), arterial hypertension (p < 0.001), LA enlargement (p < 0.001) and AF during TEE (p < 0.001) were significantly more often observed in patients showing SEC. Transient ischemic attack or stroke did not occur in any patient during AF ablation.

Conclusion

The incidence of SEC on TEE in patients prior to AF ablation was significantly lower in patients treated with NOACs as compared to patients treated with VKA. Patients with multiple risk factors showed a higher SEC incidence. The results support the recommendation of NOACs as first-line oral anticoagulation in non-valvular AF.