Prevalence of Residual Left Atrial Thrombi Among Patients With Acute Thromboembolism and Newly Recognized Atrial Fibrillation

doi:10.1001/archinte.1995.00430200078011

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Vol. 155 No. 20, 13 NOVEMBER 1995

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Prevalence of Residual Left Atrial Thrombi Among Patients With Acute Thromboembolism and Newly Recognized Atrial Fibrillation

Warren J. Manning, MD; David I. Silverman, MD; Carol A. Waksmonski, MD; Peter Oettgen, MD; Pamela S. Douglas, MD

Arch Intern Med. 1995;155(20):2193-2197.

Abstract

Background
Thromboembolism related to atrial fibrillation (AF) is a majorcause of morbidity and mortality. Patients with acute thromboembolismand AF are at high risk for early recurrent events.

Objective
To determine the prevalence of left atrial thrombi in patientswho had acute thromboembolism and newly diagnosed AF.

Patients and Methods
Adult inpatients with AF were screened to identify those withacute (<36 hours) systemic thromboembolism and newly recognizedAF. Of 41 qualifying patients, 31 (76%) agreed to undergo transesophagealechocardiographic study, including 24 with acute neurologicevents and seven with peripheral thromboembolism. A controlpopulation consisted of 88 adults with newly recognized AF withoutclinical thromboembolism.

Results
Transesophageal echocardiography identified left atrial thrombiin 13 (43%) of the 30 study patients who underwent transesophagealechocardiography compared with nine (10%) of 87 controls (P<.001).Spontaneous echo contrast was identified in 27 (87%) of thestudy population vs 42 (48%) of controls (P<.001). The prevalenceof this marker of blood stasis did not differ between patientswith left atrial thrombi without thromboembolism (P=.69). Durationof AF, prevalence of abnormal left ventricular function, leftatrial size, and mitral regurgitation were similar in both groups.

Conclusions
Left atrial thrombi were identified in more than 40% of patientswith acute thromboembolism and newly recognized AF. These datasuggest that a major source of recurrent thromboembolism inthis group may be residual thrombus migration. Among patientswith AF and atrial thrombi, clinical thromboembolism seems tooccur randomly, or is related to an unidentified process.

(Arch Intern Med. 1995;155:2193-2197)

Author Affiliations

From the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division, Beth Israel Hospital and Harvard Medical School, Boston, Mass (Drs Manning, Waksmonski, Oettgen, and Douglas); and the John Dempsey Hospital and University of Connecticut Health Center, Cardiology Division, Farmington (Dr Silverman).

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