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Features of Left Atrial Appendage Thrombosis in Patients With Persistent Nonvalvular Atrial Fibrillation After COVID-19

https://doi.org/10.18087/cardio.2023.1.n2350

Abstract

Aim      To evaluate the incidence and characteristic features of left atrial appendage (LAA) thrombosis in patients with persistent nonvalvular atrial fibrillation (AF) after COVID-19.

Material and methods  Transesophageal echocardiography (TEE) was performed for 469 patients (57.4 % males; mean age, 64.0 [58.0; 70.0] years) with persistent nonvalvular AF before scheduled sinus rhythm restoration. In 131 of these patients (27.9 %), the most recent episode of arrhythmia developed during the coronavirus infection. The time from the onset of COVID-19 to TEE was 145 [62; 303] days. All patients received an adequate anticoagulant therapy, in most cases, with direct oral anticoagulants for at least 3 weeks preceding the study.

Results A LAA thrombus was detected in 20 (5.9 %) patients who have had no coronavirus infection and in 19 (14.5 %) patients after COVID-19 (р=0.0045). 18 of 19 (94.7 %) thrombi found in patients who have had COVID-19 were mural whereas only 5 (25.0 %) of such thrombi were found in patients who have had no COVID-19 (p<0.0001). In the absence of LAA thrombus, the LAA emptying velocity was 32.0 [25.0; 40.0] cm/sec whereas in the presence of a mural thrombus, it was 25.0 [20.0; 32.3] cm/sec, and in the presence of a typical thrombus, it was 17.0 [13.5; 20.0] cm/sec (р<0.0001). A Kaplan-Meier analysis showed that the median time of mural thrombus dissolution was 35.0 (95 % confidence interval (CI), 24.0–55.0) days and for a typical thrombus, this time was 69.0 (95 % CI, 41.0–180.0) days (р=0.0018).

Conclusion      Patients with persistent AF who have had COVID-19 had LAA thrombosis 2,5 times more frequently and, in most cases, the thrombus was mural. Mural thrombi, in contrast to typical, are not associated with a pronounced decrease in LAA emptying velocity and dissolve twice as fast as typical thrombi with an adequate anticoagulant treatment.

 

About the Authors

E. S. Mazur
Tver State Medical University, Tver
Russian Federation

MD, Professor, Head of Chair of Hospital Therapy and Occupational Diseases



V. V. Mazur
Tver State Medical University, Tver
Russian Federation

MD, Chair of Hospital Therapy and Occupational Diseases



N. D. Bazhenov
Tver State Medical University, Tver
Russian Federation

Head of Chair of Emergency medical care



O. V. Nilova
Tver State Medical University, Tver
Russian Federation

Chair of Ambulatory Therapy and Family Medicine



T. O. Nikolaeva
Tver State Medical University, Tver
Russian Federation

Head of Chair of internal diseases



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Review

For citations:


Mazur E.S., Mazur V.V., Bazhenov N.D., Nilova O.V., Nikolaeva T.O. Features of Left Atrial Appendage Thrombosis in Patients With Persistent Nonvalvular Atrial Fibrillation After COVID-19. Kardiologiia. 2023;63(1):29-35. https://doi.org/10.18087/cardio.2023.1.n2350

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