Authors

• Mario Stipinović — Clinical Hospital Merkur, Zagreb, Croatia
• Sofiya Andreykanich — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0002-9334-6371
• Helena Jerkić — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0002-1650-4735
• Bojana Aćamović Stipinović — Clinical Hospital Merkur, Zagreb, Croatia
• Darko Počanić — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0003-3257-110X
• Stjepan Kranjčević — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0002-1575-1902
• Damir Kozmar — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0001-7626-3534
• Darko Vujanić — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0003-0585-5887
• Maro Dragičević — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0002-2620-3194
• Ivica Premužić Meštrović — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0002-2592-8302
• Tomislav Letilović — Clinical Hospital Merkur, Zagreb, Croatia — ORCID: 0000-0003-1229-7983

Keywords

atrial fibrillation, thrombus, left atrial appendage

DOI

Full Text

**Introduction:** The incidence of atrial fibrillation is increasing and it is now the most common arrhythmia in clinical practice (1). Primary therapeutic goal in patients with atrial fibrillation is to prevent thromboembolic complications (2). The aim of this study was to determine the incidence as well as risk factors for left atrial appendage (LAA) thrombus formation, detected with transesophageal echocardiography (TEE), in patients with atrial arrhythmias and planned cardioversion. **Patients and Methods:** Patients with atrial arrhythmias, scheduled for synchronized cardioversion at the Department of Cardiology, Clinical Hospital Merkur in years 2014 and 2015 were studied. All patients were treated with different anticoagulation/antiaggregation protocols according to the most recent guidelines. TEE was done before every procedure. We studied various isolated risk factors known or believed to be associated with development of left atrial appendage thrombus, such as: age, sex, type of anticoagulation therapy, duration of therapy, systolic heart function and type of atrial arrhythmia. We also studied influence of coexistence of various risk factors, expressed as CHA2DS2-VASc score≥2, on LAA thrombus formation. **Results:** Data from 65 patients were gathered (mean age 65.5±11.7, mean CHA2DS2-VASc score 2, 40% female, 60% male). In 14 subjects (21.5%), despite adequate anticoagulation/antiaggregation therapy, the thrombus in LAA was discovered. We found no statistically significant correlation between isolated risk factors, that were studied, and LAA thrombus formation. On the other hand statistical analysis showed correlation of LAA thrombus formation with CHA2DS2-VASc score equal or higher than 2 (p=0.017). In fact all 14 patients with thrombus (100%) had a CHA2DS2-VAScof that value. **Conclusion:** There is still a significant risk of LAA thrombus in patients with atrial arrhythmias despite adequate anticoagulation therapy. LAA thrombus formation in those patients correlates with coexistence of several rather than one risk factor.

Literature

1. Munger TM, Wu LQ, Shen WK. Atrial fibrillation. J Biomed Res. 2014 Jan;28(1):1–17. https://doi.org/10.7555/JBR.28.20130191
2. Crandall MA, Bradley DJ, Packer DL, Asirvatham SJ. Contemporary management of atrial fibrillation: update on anticoagulation and invasive management strategies. Mayo Clin Proc. 2009;84(7):643–62. https://doi.org/10.1016/S0025-6196(11)60754-4