Pediatric/Adult Congenital Heart Disease -> Adult Congenital Heart Disease D-PO02 - Poster Session II (ID 47) Poster

D-PO02-072 - Difference In Incidence Of Intra-Cardiac Thrombus On Presentation In Congenital Heart Disease Patients With Atrial Fibrillation And Atrial Flutter (ID 1001)


Background: Guidelines recommend trans-esophageal echocardiography (TEE) for patients with atrial fibrillation (AF) or flutter (AFL) for longer than 48 hours, due to the risk of intra-cardiac thrombus formation. These were adopted for the congenital heart disease (CHD) population, despite limited data as to their applicability. There is growing evidence that AFL in adults with structurally normal hearts has less thrombogenic potential, with the need for TEE questioned. There is no data as to whether this applies to CHD as well.
Objective: Compare incidence of intra-cardiac thrombus via TEE in CHD patients presenting in stable AF and AFL.
Methods: Single center, retrospective analysis for unique first-time presentations of patients for either AF, AFL or intra-atrial reentrant tachycardia (IART) between 2000 - 2019. Patients categorized based on presenting atrial arrhythmia (AF vs. AFL/IART) with exclusion criteria being chronic anti-coagulation prior to TEE and presentation for reason other than TEE examination of thrombus prior to direct current cardioversion (DCCV). Incidence of thrombus also examined in relation to cardiac complexity.
Results: 201 patients with CHD with presenting event of TEE with AF or AFL. 108 patients (29 AF, 79 AFL) met inclusion criteria, with no difference in median age at presentation between AF (median 25 yrs; range 12-57 yrs) and AFL (23 yrs; 1-65 yrs). Incidence of intra-cardiac thrombus in the cohort was 9%, with no statistical difference between the AF (14%) and AFL groups (8%), p=0.32. Patients with thrombus tended to be older in the AF group (29.3 vs 25.9 years, p=0.29), with no difference in systemic ventricular function or CHADS2/CHA2DS2VASc score at presentation. 3/4 (75%) AF patients with thrombus had moderate/high complexity heart disease, 1 of whom had a Fontan, compared to 4/6 (67%) AFL patients, 1 of whom had a Fontan, p=0.7.
Conclusion: Risk for intra-cardiac thrombus is high in the CHD population, with 14% of AF and 8% of AFL patients having clot on their initial presentation. Compared to the non-CHD population, this risk is similar for AF patients and higher for AFL patients. There appear to be no distinguishing factors to warrant change in the recommendations for TEE, with all levels of cardiac complexity being at risk for clot.