Patient cohort
LAA thrombi, LAA thrombus, infections, acute coronary syndromes, thrombus, pulmonary vein isolation
ACUTE CORONARY SYNDROMES, THROMBUS, INFECTIONS
Between January 2010 and December 2015, 7759 consecutive patients diagnosed with symptomatic AF were admitted to our heart center. Definition of the different types of AF (paroxysmal, persistent, permanent) followed the guidelines for treatment of AF 2012The primary therapeutic goal was to restore sinus rhythm. When no thrombus was present, sinus rhythm was restored with antiarrhythmic drugs (amiodarone, class I antiarrhythmics), electric cardioversion (e CV) and/or pulmonary vein isolation (PVI). There was no follow-up in patients without LAA thrombi and restored sinus rhythm. When a LAA thrombus was detected (“first hospital visit”, “first TOE”), a revisit with another TOE examination was scheduled 3–4 month later. In case of LAA thrombus persistence at the first revisit, another appointment was arranged in 3–4 month. All revisits included TOE examination. This was repeated up to four times. The therapeutic goal for patients with LAA thrombi on vitamin K antagonists was increased to an international normalized ratio (INR) of 2.5–3.5 to promote thrombus resolution. New oral anticoagulants (NOAKs) were given at the highest recommended dosages, if possible. Treatment included heart rate lowering medication, antihypertensive drugs, state- of- the- art heart failure medication and medication to treat cardiovascular risk factors. When LAA thrombi did not resolve or patients became asymptomatic under therapy and AF was accepted as permanent rhythm, AF was considered to be permanent. AF was also considered to be permanent, when repeated e CVs and PVI including pretreatment with amiodarone did not restore sinus rhythm. TOE reevaluation ended (“last hospital visit” or “last TOE”) either when LAA thrombus had resolved and procedures to restore sinus rhythm were safe to perform or when AF was declared as “permanent”. Patients with acute coronary syndromes and infections were excluded in this study.Written informed consent was obtained from all patients for invasive procedures. Informed consent of patients was obtained to be contacted by phone. The study was approved by the ethics committee of the Philipps University of Marburg, Department of Medicine. All methods were performed in accordance with the relevant guidelines and regulations as outlined in the Declaration of Helsinki.
