Atrial Thrombus Exclusion Score

Oct 31, 2018
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Authors:
Milhem A, Ingrand P, Tréguer F, et al.
Citation:
Exclusion of Intra-Atrial Thrombus Diagnosis Using D-Dimer Assay Before Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2018;Oct 31:[Epub ahead of print].
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Study Questions:

Can the D-dimer blood level and other clinical items predict the absence of atrial thrombus?

Methods:

The authors studied 2,494 patients admitted for catheter ablation of atrial fibrillation in a multicenter study. A transesophageal echocardiogram was performed routinely before the ablation procedure. D-dimer levels, CHADS2 score, left ventricular ejection fraction, preoperative anticoagulation, and medical history details were collected for all patients. The authors used logistic regression to develop a risk prediction score for the absence of atrial thrombus.

Results:

The incidence of atrial thrombus was 1.92%. CHADS2 and D-dimer levels were associated with the presence of atrial thrombus. A CHADS2 = 0 had a sensitivity of 90% and a specificity of 52% for excluding atrial thrombus. Patients with an “Atrial Thrombus Exclusion” (ATE) score of zero (no history of stroke, congestive heart failure, hypertension, or an elevated D-dimer level) had no atrial thrombi identified (sensitivity 100%, specificity 37%).

Conclusions:

The authors concluded that an ATE score of zero was strongly associated with the absence of atrial thrombus among patients with atrial fibrillation.

Perspective:

While the D-dimer has long been used to help rule out venous thromboembolism, this study uses the D-dimer along with some clinical characteristics of the CHADS2 score to rule out atrial thrombus in patients with atrial fibrillation. If replicated and validated, this score may be useful in reducing the need to perform a transesophageal echocardiogram on every patient prior to catheter ablation or cardioversion of atrial fibrillation.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Anticoagulation Management and Atrial Fibrillation, Anticoagulation Management and Venothromboembolism, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Echocardiography, Transesophageal, Electric Countershock, Heart Failure, Hypertension, Stroke, Stroke Volume, Thrombosis, Vascular Diseases, Venous Thromboembolism


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