AUTHOR=Uziȩbło-Życzkowska Beata , Kapłon-Cieślicka Agnieszka , Gawałko Monika , Budnik Monika , Starzyk Katarzyna , Wożakowska-Kapłon Beata , Daniłowicz-Szymanowicz Ludmiła , Kaufmann Damian , Wójcik Maciej , Błaszczyk Robert , Hiczkiewicz Jarosław , Łojewska Katarzyna , Mizia-Stec Katarzyna , Wybraniec Maciej , Kosmalska Katarzyna , Fijałkowski Marcin , Szymańska Anna , Gos Aleksandra , Haberka Maciej , Kucio Michał , Michalski Błazej , Kupczyńska Karolina , Tomaszuk-Kazberuk Anna , Wilk-Śledziewska Katarzyna , Wachnicka-Truty Renata , Koziński Marek , Burchardt Paweł , Krzesiński Paweł 

TITLE=Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.973043

DOI=10.3389/fcvm.2022.973043

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Our aim was to assess the characteristics and to identify predictors of left atrial thrombus (LAT) in patients under age 65 with atrial fibrillation (AF) or atrial flutter (AFl).</p></sec><sec><title>Methods</title><p>We conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled.</p></sec><sec><title>Results</title><p>Of the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT (<italic>n</italic> = 76) had higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (<italic>p</italic> &lt; 0.001), more frequently had non-paroxysmal AF/AFl (<italic>p</italic> &lt; 0.001), heart failure (<italic>p</italic> &lt; 0.001), history of diabetes mellitus (<italic>p</italic> = 0.001), transient ischemic attack (<italic>p</italic> = 0.04), coronary artery disease (<italic>p</italic> = 0.02), and chronic kidney disease (<italic>p</italic> &lt; 0.001). The LAT patients were also more often smokers (<italic>p</italic> = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) (<italic>p</italic> &lt; 0.001). Transthoracic echocardiography revealed a higher left atrial area (<italic>p</italic> &lt; 0.001), lower left ventricular ejection fraction (LVEF) (<italic>p</italic> &lt; 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients (<italic>p</italic> &lt; 0.001). LVEF (OR 2.95; 95% CI: 1.32–6.59, <italic>p</italic> = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05–24.63, <italic>p</italic> = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48–9.75, <italic>p</italic> &lt; 0.001) were identified as independent predictors of LAT in younger patients.</p></sec><sec><title>Conclusions</title><p>Our study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs.</p></sec>