Clinical characteristics and prognosis of the patients with nonvalvular atrial fibrillation combining left atrial thrombosis and the efficacy of the anticoagulant drugs

Objective To analysis clinical characteristics and prognosis of the patients with nonvalvular atrial fibrillation(NVAF)combining left atrial thrombosis(LAT)and compare the clinical efficacy of new anticoagulant drugs(NOACs)and warfarin. Methods This study included 101 consecutive NVAF patients referred to our center for catheter ablation and confirmed diagnosis of LAT by transoesophageal echocardiography(TEE)or multidetector computed tomography from January 2016 to December 2017.All patients were anticoagulated with NOACs or warfarin for at least 3 weeks and then performed TEE to evaluate the LAT.This was a single center retrospective study. Results A total of 101 patients were included in this study and 75(74.3%)patients had persistent AF.During follow-up, 95(94.1%)patients were regular anticoagulant drugs and analyzed.LAT was disappeared in 73(76.8%)patients and not in 22(23.2%)patients.Compared with the LAT disappeared group, the LAT not disappeared group had significantly more patients with persistent AF(90.9% vs.69.9%, P<0.05), cardiomyopathy(27.3% vs.5.5%, P<0.05)and CHA2DS2-VASc score≥3 for male or ≥4 for female(50.0% vs.20.5%, P<0.05), respectively.The LAT disappeared group had significantly more patients treated with NOACs than the LAT not disappeared group(75.0% vs.45.5%, P<0.05). LAT was disappeared significantly more in patients on NOAC than that in patients on warfarin(84.8% vs.61.3%, P<0.05). Two independent predictors for disappear of LAT were identified: treated with NOACs and LVEF≥50%. Conclusion The LAT were more likely to disappear in NVAF patients treated with NOACs.When NVAF patients who referred for catheter ablation combined with LAT, a NOACs is recommended in preference to warfarin. Key words: Anticoagulants; Left atrial thrombosis; Warfarin