PREVALENCE OF ATRIAL THROMBOSIS AND SPONTANEOUS ECHO CONTRAST IN PATIENTS WITH ATRIAL FIBRILLATION AND FLUTTER

To compare the prevalence of atrial thrombosis and the spontaneous echo contrast phenomenon (SEC) in patients with atrial fibrillation (AF) and atrial flutter (AFL) at the background of/without antithrombotic therapy (ATT), 205 patients with persistent non-valvular AF or AFL lasting for more than 48 hours were examined. In the study subjects, transesophageal echocardiography (TE EchoCG) was performed to assess whether the sinus rhythm can recover. The study group included 116 men (56.6%) and 89 women (43.4%) aged 20 81 years (median age: 60.0 years). Atrial fibrillation was documented in 140 study subjects (68.3%); atrial flutter, in 65 patients (31.7%). The idiopathic arrhythmia was observed in 44 patients (21.5%); other patients had primary diseases which could potentially lead to development of AF and AFL. TE EchoCG and transthoracic echocardiography (TT EchoCG) was performed using the Vivid E9 device (General Electric, USA). The left auricle (LAU) assessment during TE EchoCG was performed from the medium esophageal access. During TT EchoCG., the left ventricle ejection fraction (EF) was assessed and the maximal left atrial volume (LAV) and right atrial volume (RAV) were measured. During TE EchoCG, the LAU thrombus was observed in 62 patients (30.2%), SEC, in 103 patients (50.2%), and the high-degree SEC (Stage III IV), in 37 patients (18.0%). SEC was revealed in 82.3% (72.7-91.8) of cases in patients with the LAU thrombus and in 36.4% (28.5-44.2) of cases in the patients without thrombi. High-degree SEC was documented in 50.0% (37.6-62.4) and 4.2% (0.9-7.5) of cases, respectively (p<0.001 in both cases). Thus, SEC and especially high-degree SEC are found more frequently in the AF patients with the LAU thrombus than in those without thrombi. By the time of TE EchoCG assessment, the pre-cardioversion antithrombotic therapy has been conducted in 87 patients (62.1%) with AF and 29 patients (32.5%) with AFL. Other patients were free from anticoagulant therapy. The LAU thrombus in patients with ATT was found in 27.6% (18.2-37.0) of cases of AF and in 0.0% (0.0-11.7) of cases of AFL (p<0.01) and, in ATT-free patients, in 56.6% (43.3-69.9) and 22.2% (8.6-35.8) of cases, respectively (p<0.02). The above data show that both ATT and the type of arrhythmia have a statistically significant influence on the thrombogenesis rate (χ2=25.4; p<0.001); the most significant influence of arrhythmia occurred at the background of ATT, and the most significant influence of ATT took place in patients with AFL. Two-way ANOVA test showed that the LAU circulation velocity depends on the presence of thrombus (F=226.2; p<0.001) as well as on the type of arrhythmia (F=14.2; p<0.01); the influence of the former factor is considerably more significant. In addition to the LAU thrombus and the type of arrhythmia, the LAU circulation velocity is influenced by the state of the left ventricle diastolic function; in the case of altered diastolic function, an approximately 6-fold increased thrombosis rate occurs from 5.5% (1.9 14.9) to 34.4% (22.5-46.3) in patients receiving ATT and from 11.9% (5.2-25.0) to 70.2% (57.1-83.3) in patients free from ATT. Thus, in the patients with AF, thrombi in LAU are revealed more frequently than in the patients with AFL, the SEC phenomenon is revealed with the same frequency. At the background of ATT., the LAU thrombogenesis improves but the SEC prevalence does not change. Irrespective of the arrhythmia type and intake of anticoagulants, the LAU thrombosis and SEC phenomenon are revealed more frequently in patients with an altered left ventricular diastolic function than with the normal one.

atrial fibrillation, atrial flutter, left auricle, spontaneous echo contrast phenomenon, transesophageal echocardiography, antithrombotic therapy

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