Abstract:
OBJECTIVES:The objective of this study was to determine the frequency of left atrial thrombus in patients with acute atrial fibrillation. BACKGROUND:It is commonly assumed but unproved that left atrial thrombus in patients with atrial fibrillation begins to form after the onset of atrial fibrillation and that it requires > or = 3 days to form. Thus, patients with acute atrial fibrillation (i.e., < 3 days) frequently undergo cardioversion without anticoagulation prophylaxis. METHODS:Three hundred seventeen patients (250 men, 67 women; mean [+/- SD] age 64 +/- 12 years) with acute (n = 143) or chronic (n = 174) atrial fibrillation were studied by two-dimensional transesophageal echocardiography. RESULTS:Left atrial appendage thrombus was present in 20 patients (14%) with acute and 47 patients (27%, p < 0.01) with chronic atrial fibrillation. In patients with a recent embolic event, the frequency of left atrial appendage thrombus did not differ between those with acute (5 [21%] of 24) and those with chronic (12 [23%] of 52, p = NS) atrial fibrillation. Patients with acute versus chronic atrial fibrillation, respectively, did not differ (p = NS) in mean age (64 +/- 13 vs. 65 +/- 11 years), frequency of concentric left ventricular hypertrophy (32% vs. 26%), hypertension (32% vs. 41%), coronary artery disease (35% vs. 39%), congestive heart failure (43% vs. 48%), mitral stenosis (4% vs. 7%) or mitral valve replacement (1.4% vs. 6%). The minimally detectable difference in proportions between patients with acute and chronic atrial fibrillation based on a power of 0.80 and base proportion of 0.20 was 14%. CONCLUSIONS:Left atrial thrombus does occur in patients with acute atrial fibrillation < 3 days in duration. The frequency of left atrial thrombus in patients with recent emboli is comparable between those with acute and chronic atrial fibrillation. These data suggest that patients with acute atrial fibrillation for < 3 days require anticoagulation prophylaxis or evaluation by transesophageal echocardiography before cardioversion and should not be assumed to be free of left atrial thrombus.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Stoddard MF,Dawkins PR,Prince CR,Ammash NMdoi
10.1016/0735-1097(94)00396-8subject
Has Abstractpub_date
1995-02-01 00:00:00pages
452-9issue
2eissn
0735-1097issn
1558-3597pii
0735-1097(94)00396-8journal_volume
25pub_type
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journal_title:Journal of the American College of Cardiology
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abstract::The current study determined the effectiveness of nicardipine, a 1,4-dihydropyridine calcium antagonist, in preserving reperfused myocardium in a cat model of temporary coronary occlusion and ascertained if replenishment of myocardial phosphate stores during reperfusion as defined by phosphorus-31 nuclear magnetic res...
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更新日期:1998-05-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究
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更新日期:2019-08-20 00:00:00
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:1986-01-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2017-07-18 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2009-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2009-04-14 00:00:00