P6365Clinical predictors of left atrium thrombi in patients scheduled for cardioversion of atrial fibrillation: a subanalysis from the ENSURE-AF study

Abstract

Background: The ENSURE-AF study (NCT 02072434) was the largest prospective randomised clinical trial of anticoagulation for cardioversion in non-valvular atrial fibrillation (AF), which also provides the largest prospective dataset for transesophageal echocardiography (TEE) prior to cardioversion in this clinical setting. Purpose: This analysis investigated clinical predictors of TEE-detected left atrium thrombi (LAT) in patients scheduled for electrical cardioversion (ECV) of AF. Methods: ENSURE-AF was a multicentre, PROBE evaluation trial, comparing edoxaban 60 mg QD with enoxaparin-warfarin in 2199 patients undergoing ECV of non-valvular AF. Patients were stratified in accordance with the use of TEE, anticoagulant experience, and selected edoxaban dose. Electrical cardioversion was cancelled or deferred if LAT present. Patients with and without LAT were compared using demographic (age, sex, body mass index-BMI), clinical (CHA2DS2- VASc and HAS-BLED scores and components, prior myocardial infarction), and treatment (naïve or experienced to anticoagulation, treated with anticoagulants 30 days prior to enrolment, INR at enrolment, diuretic treatment) data were compared. Results: 1183 patients were stratified to the TEE arm and LAT were reported by the investigator in 91 (8.2%). Univariate analysis showed that age ≥75 years (26.4% vs 16.9%, P=0.0308), heart failure (59.3% vs 43.0%, P=0.0029) and diuretic treatment (53.9% vs 40.1%, P=0.0141) were more common in the LAT group. No statistical difference was seen for lower mean CHA2DS2-VASc score (1.41 vs 1.48, P=0.0571) and more frequent use of anticoagulation 30 days prior to enrolment (60.4% vs 50.3%, P=0.0795) in the LAT group. A logistic regression analysis with the former variables was performed and showed that only age (P=0.0013) and heart failure (P=0.0008) were independently associated with the detection of LAT on TEE. Age ≥75 years and heart failure predicted the presence of LAT, which was found in 12.2% and 10.9% of patients with these variables, respectively. Conclusion: Elective ECV is commonly cancelled or deferred due to occurrence of TEE detected LAT in patients with non-valvular AF. Age ≥75 years and heart failure predicted the presence of LAT. The use of anticoagulation during the 30 days prior to ECV did not influence the detection rate of LAT. (Table Presented).