Isoproterenol-Assisted Differentiation Between Sludge and Organized Thrombus to Guide Left Atrial Appendage Occlusion

Sandeep K Goyal; Syed Hyder; Shizhen Liu; Mani A Vannan

doi:10.1016/j.jacep.2022.10.026

Isoproterenol-Assisted Differentiation Between Sludge and Organized Thrombus to Guide Left Atrial Appendage Occlusion

JACC Clin Electrophysiol. 2023 Jan;9(1):111-116. doi: 10.1016/j.jacep.2022.10.026. Epub 2022 Nov 30.

Authors

Sandeep K Goyal¹, Syed Hyder², Shizhen Liu³, Mani A Vannan³

Affiliations

¹ Division of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA. Electronic address: sandeep.goyal@piedmont.org.
² Division of Cardiac Electrophysiology, Piedmont Heart Institute, Atlanta, Georgia, USA.
³ Division of Cardiovascular Imaging, Piedmont Heart Institute, Atlanta, Georgia, USA.

PMID: 36697189
DOI: 10.1016/j.jacep.2022.10.026

Abstract

Percutaneous left atrial appendage occlusion (LAAO) is contraindicated in presence of left atrial appendage (LAA) thrombus. It is often difficult to separate LAA sludge from an organized thrombus on transesophageal echocardiography. The inability to differentiate sludge from thrombus leads to patients not receiving LAAO despite contraindication to long-term anticoagulation. Retrospective 6-month follow-up outcomes are reported on patients undergoing LAAO in presence of LAA sludge cleared by isoproterenol. This study showed no increased risk of transient ischemic attack/stroke in the 6 months following LAAO in the presence of LAA sludge, which was cleared with isoproterenol. This study suggests a role for isoproterenol in differentiating sludge from thrombus.

Keywords: LAAO; isoproterenol; sludge; stroke; thrombus.

Publication types

Review

MeSH terms

Atrial Appendage* / diagnostic imaging
Atrial Appendage* / surgery
Atrial Fibrillation* / complications
Atrial Fibrillation* / surgery
Heart Diseases* / etiology
Humans
Isoproterenol / therapeutic use
Retrospective Studies
Sewage
Thrombosis* / etiology

Substances

Isoproterenol
Sewage