Arrhythmias & electrophysiologyCross-sectional study
Diagnostic and therapeutic pathways for the malignant left atrial appendage: European Heart Rhythm Association physician survey
- Cross-sectional physician survey
- online questionnaire
- 18-item
Authors' conclusion
Currently, the majority of patients are treated on an outpatient basis with either shifting from VKA to DOAC or from one DOAC to another. Left atrial appendage closure in this population seems to be reserved for patients with higher bleeding risk or complications of malignant LAA, such as stroke.
Study context
- Population
- Physicians at European cardiac centres managing malignant left atrial appendage (LAA) (AF patients with SSE despite OAC or LAA thrombus)
- Participants
- 196 physicians
- Outcome
- Diagnostic and therapeutic pathways for malignant LAA in practice
Main finding
As reported in the abstract
Diagnostic and therapeutic pathways for malignant LAA
- High confidence in transoesophageal echocardiography (TEE) imaging for LAA thrombus diagnosis
- Preferred initial treatment: switch to another direct oral anti-coagulant (DOAC), then switch to vitamin K antagonist (VKA), low-molecular-weight heparin, or continued/optimised DOAC dosage; LAA closure the last option
- LAA closure a viable option in embolic stroke despite OAC with no thrombus at TEE (empty LAA) after comprehensive exclusion of other embolic sources
Observational data: associations, not effects.
Original publication
Diagnostic and therapeutic pathways for the malignant left atrial appendage: European Heart Rhythm Association physician survey. Europace. Published 13 July 2023. doi:10.1093/europace/euad204
Summarised from the published abstract; every number is checked against it