O.S. Sychov, A.O. Borodai, Yu.V. Zinchenko, E.S. Borodai, S.I. Deyak Left atrial thrombus and/or sludge resolution and cardioversion in patients with non-valvular atrial fibrillation – flutter at repeated transoesophageal echocardiography

The aim – to evaluate the rate of resolution of left atrial appendage (LAA) thrombus and sludge after the use of anticoagulation therapy and evaluate the safety of cardioversion in patients with residual LAA thrombus and/or sludge on repeated transoesophageal echocardiography (TOE).

Material and methods. 39 patients with LAA thrombus and/or sludge on baseline TOE were included into the prospective observational study. The mean age was 61.7±9.5 years, mean CHA2DS2-VASc score 2.85±1.3, 11 (28.2 %) were females.

Results. There were 27 patients with LAA thrombus, 22 with LAA sludge, in 10 (45.45 %) cases thrombus was accompanied with sludge. After detection of thrombus and/or sludge, anticoagulation therapy was prescribed for 51.8±10.7 days before next TOE. Warfarin was prescribed in 19 (48.72 %) cases and treatment with novel oral anticoagulants (NOAC) – in 20 (51.28 %) patients. Complete thrombus resolution was noted in 18 (66.7 %) out of 27 cases, similar in both groups: in warfarin group it was found in 4/12 (33.3 %) and in NOAC group in 5/15 (33.3 %) of cases. In all cases residual thrombi had reduced size and were immobile. Sludge resolution rate was noted in 9 (40.9 %) out of 22: in warfarin group it was found in 7/11 (63.64 %) and in NOAC group – in 6/11 (54.55 %) cases. Cardioversion was registered in 14 (56 %) of patients with residual thrombus and/or sludge, among them 7 were with residual LAA thrombus: 3 patients had spontaneous cardioversion during first 30 days of follow-up, and DCC was performed in 4 highly symptomatic patients. There were no stroke or thromboembolic events during 30 days of follow-up. All patients were highly adherent to anticoagulation therapy.

Conclusions. Residual thrombi are frequent founding at repeated TOE. It seems that cardioversion might be considered in patients with reduced and immobile thrombi, being adherent to anticoagulation therapy.

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