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Persistence of left atrial thrombus in patients with hypertrophic cardiomyopathy and atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

We recently demonstrated that patients with atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) have an increased risk of left atrial (LA) thrombus. In this study, we aimed to evaluate thrombus management, thrombus persistence, and thromboembolic events for HCM and non-HCM patients with AF and LA thrombus.

Methods

From a cohort of 2,155 AF patients undergoing transesophageal echocardiography (TEE) for any indication, this study included 122 patients with LA thrombus (64 HCM patients and 58 non-HCM controls).

Results

There was no difference in mean CHA2DS2-VASc scores between HCM and control patients (3.9 ± 2.2 vs 3.8 ± 2.0, p = 0.88). Ten (16%) and 4 (7%) patients in the HCM and control groups, respectively, were in sinus rhythm at the time of TEE identifying the LA thrombus (p = 0.13). In all patients, the anticoagulation strategy was modified after the LA thrombus diagnosis. A total of 36 (56%) HCM patients and 34 (59%) control patients had follow-up TEE at median 90 and 62 days, respectively, after index TEE. The HCM group had significantly higher 90-day rates of persistent LA thrombus compared to the control group (88% vs 29%; p < 0.001). In adjusted models, HCM was independently associated with LA thrombus persistence. Among patients with LA thrombus, the 5-year cumulative incidence of thromboembolic events was 11% and 2% in HCM and control groups, respectively (p = 0.22).

Conclusions

Among patients with AF with LA thrombus identified by TEE, those with HCM appear to have a higher risk of LA thrombus persistence than non-HCM patients despite anticoagulation.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AF:

Atrial fibrillation / flutter

HCM:

Hypertrophic cardiomyopathy

DOAC:

Direct oral anticoagulant

INR:

International normalized ratio

LA:

Left atrium

LAA:

Left atrial appendage

TEE:

Transesophageal echocardiogram

References

  1. Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. J Am Heart Assoc. 2014;3: e001002.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rowin EJ, Hausvater A, Link MS, et al. Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy. Circulation. 2017;136:2420–36.

    Article  PubMed  Google Scholar 

  3. Burczak D, Julakanti R, Kara Balla A, et al. Risk of Left Atrial Thrombus in Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation. J Am Coll Cardiol. 2023Jul;82(3):278–9.

    Article  PubMed  Google Scholar 

  4. Noseworthy PA, Yao X, Shah ND, Gersh BJ. Stroke and Bleeding Risks in NOAC- and Warfarin-Treated Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation. J Am Coll Cardiol. 2016;67:3020–1.

    Article  PubMed  Google Scholar 

  5. Dominguez F, Climent V, Zorio E, et al. Direct oral anticoagulants in patients with hypertrophic cardiomyopathy and atrial fibrillation. Int J Cardiol. 2017;248:232–8.

    Article  PubMed  Google Scholar 

  6. Jung H, Yang PS, Jang E, et al. Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy: A Nationwide Cohort Study. Chest. 2019;155:354–63.

    Article  PubMed  Google Scholar 

  7. Di Cori A, Barletta V, Meola L, et al. Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation. J Interv Card Electrophysiol. 2022;64(3):773–81. https://doi.org/10.1007/s10840-022-01169-1.

    Article  PubMed  Google Scholar 

  8. Wu MS, Gabriels J, Khan M, et al. Left atrial thrombus despite continuous direct oral anticoagulant or warfarin therapy in patients with atrial fibrillation: insights into rates and timing of thrombus resolution. J Interv Card Electrophysiol. 2018;53(2):159–67. https://doi.org/10.1007/s10840-018-0432-1.

    Article  PubMed  Google Scholar 

  9. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020;76:e159–240.

    Article  PubMed  Google Scholar 

  10. Lurie A, Wang J, Hinnegan KJ, et al. Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol. 2021;77:2875–86.

    Article  PubMed  Google Scholar 

  11. El-Am EA, Dispenzieri A, Melduni RM, et al. Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis. J Am Coll Cardiol. 2019;73:589–97.

    Article  PubMed  PubMed Central  Google Scholar 

  12. El-Am EA, Grogan M, Ahmad A, et al. Persistence of Left Atrial Appendage Thrombus in Patients With Cardiac Amyloidosis. J Am Coll Cardiol. 2021;77:342–3.

    Article  PubMed  Google Scholar 

  13. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1-76.

    Article  PubMed  Google Scholar 

  14. Diab M, Wazni OM, Saliba WI, et al. Ablation of Atrial Fibrillation Without Left Atrial Appendage Imaging in Patients Treated With Direct Oral Anticoagulants. Circ Arrhythm Electrophysiol. 2020;13:e008301.

    Article  PubMed  Google Scholar 

  15. Di Biase L, Briceno DF, Trivedi C, et al. Is transesophageal echocardiogram mandatory in patients undergoing ablation of atrial fibrillation with uninterrupted novel oral anticoagulants? Results from a prospective multicenter registry. Heart Rhythm. 2016;13:1197–202.

    Article  PubMed  Google Scholar 

  16. Whitlock RP, Belley-Cote EP, Paparella D, et al. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med. 2021;384:2081–91.

    Article  PubMed  Google Scholar 

  17. Sun D, Schaff HV, Nishimura RA, et al. Patient-Reported Atrial Fibrillation After Septal Myectomy for Hypertrophic Cardiomyopathy. Ann Thorac Surg. 2022;113:1918–24.

    Article  PubMed  Google Scholar 

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Funding

Statistical support was provided by internal departmental funds. No other funding was obtained.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Daniel R. Burczak, Raghav R. Julakanti, Abdalla Kara Balla, Khaled Ismail, Jeffrey B. Geske, Ammar M. Killu, Abhishek J. Deshmukh, Ciorsti J. MacIntyre, Steve R. Ommen, Vuyisile T. Nkomo, Bernard J. Gersh, Peter A. Noseworthy & Konstantinos C. Siontis

  2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Christopher G. Scott

  3. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    William H. Swain

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  1. Daniel R. Burczak
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  2. Christopher G. Scott
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  15. Konstantinos C. Siontis
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Corresponding author

Correspondence to Konstantinos C. Siontis.

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Ethics Approval

This research study was conducted using retrospective data available in the medical record for patients with general research authorization. An IRB official waiver of ethical approval was granted from the IRB of Mayo Clinic.

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The authors have no relevant financial or non-financial interests to disclose.

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Burczak, D.R., Scott, C.G., Julakanti, R.R. et al. Persistence of left atrial thrombus in patients with hypertrophic cardiomyopathy and atrial fibrillation. J Interv Card Electrophysiol (2023). https://doi.org/10.1007/s10840-023-01642-5

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