Atrial thrombus detection on transoesophageal echocardiography in patients with atrial fibrillation undergoing cardioversion or catheter ablation: A pooled analysis of rates and predictors

Objective: To summarize data on the rates and predictors of left atrial thrombus/ left atrial appendage thrombus (LAT/LAAT) detection by transoesophageal echocardiography (TEE) before electrical cardioversion (ECV) or catheter ablation (CA) for atrial fibrillation (AF). Methods: EMBASE, MEDLINE, and Web of Science Core Collection were searched to identify all studies providing relevant data and published by October 7, 2020. A random‐effects meta‐analysis method was used to pool effect size estimates. Results: A total of 85 studies were included, reporting data from 56 660 patients with AF. In patients undergoing CA and ECV, the pooled prevalence of LAT/LAAT was 1.8% and 7.5% in those not on oral anticoagulation (OAC), 1.8% and 5.5% in those taking OAC, and 1.3% and 4.9% in case of adequate OAC, respectively. According to the type of OAC, the prevalence was 2.0% and 7.6% for vitamin K antagonist, 1.3% and 3.5% for direct oral anticoagulant. Predictors of LAT/LAAT detection were nonparoxysmal AF (odds ratio [OR]: 3.6, 95% confidence interval: 2.4–5.2), hypertension (OR: 2.9, 1.2–7.0), previous stroke (OR: 3.0, 1.6–5.63), heart failure (OR: 4.3, 2.7–6.8), and CHADS2 score ≥2 (OR: 3.3, 1.9–5.8) for patients undergoing CA; and heart failure (OR: 2.8, 1.3–6.2) and the CHA2DS2‐VASc score (OR: 2.55, 1.5–4.5) for those undergoing ECV. Conclusion: The prevalence of LAT/LAAT in AF patients undergoing ECV or CA varies widely, mainly due to differences in patient risk profiles and OAC types. Further research should determine whether the predictors of LAT/LAAT detection identified by this study could be used to select patients who require preprocedural TEE.Jean Jacques Noubiap, Thomas A. Agbaedeng, Aude Laetitia Ndoadoumgue, Ulrich Flore Nyaga, Andre Pascal Kengn

Meta-analysis comparing the frequency of carotid artery stenosis in patients with atrial fibrillation and vice versa

Atrial fibrillation (AF) and carotid stenosis (CS) can co-exist and this association has been reported to result in a higher risk of stroke than attributed to either condition alone. Here we aimed to summarize the data on the association of CS and AF. MEDLINE and Embase were searched to identify all published studies providing relevant data through 27 February 2020. Random-effects meta-analysis method was used to pool estimates of prevalence. Heterogeneity was assessed by mean I-squared statistic. Forty-eight studies were included, 20 reporting on the prevalence of carotid disease in a pooled population of 49,070 AF patients, and 28 on the prevalence of AF in a total of 2,288,265 patients with carotid disease. The pooled prevalence of CS in AF patients was 12.4% (95% CI 8.7-16.0, I2 93%; n = 3919), ranging from 4.4% to 24.3%. The pooled prevalence of carotid plaque was 48.4% (95% CI 35.2-61.7, I2 = 99%; n = 4292). The prevalence of AF in patients with CS was 9.3% (95% CI 8.7-10.0, I2 99%; n = 2,286,518), ranging from 3.6% to 10.0%. This prevalence was much higher (p .05). In conclusion, AF and CS frequently co-exist, with about one in ten patients with AF having CS, and vice versa. In addition, non-stenotic carotid disease is present in about half of AF patients. These findings have important implications for AF screening in patients with CS, stroke prevention and the opportunities to intervene on common risk factors.Jean Jacques Noubiap, Thomas A. Agbaedeng, Joel Noutakdie Tochie, Jan Rene Nkeck, Aude Laetitia Ndoadoumgue, John L. Fitzgerald ... et al

Prevalence and Factors Associated with Symptom Persistence: A Prospective Study of 429 Mild COVID-19 Outpatients

Introduction. Persistent symptoms have recently emerged as a clinical issue in COVID-19. We aimed to assess the prevalence and risk factors in symptomatic non-hospitalized individuals with mild COVID-19. Methods. We performed a prospective cohort study of symptomatic COVID-19 outpatients, from March to May 2020, with weekly phone calls from clinical onset until day 30 and up to day 60 in case of persistent symptoms. The main outcomes were the proportion of patients with complete recovery at day 30 and day 60 and factors associated with persistent symptoms. Results. We enrolled 429 individuals mostly women (72.5%) and healthcare workers (72.5%), with a median age of 41.6 years [IQR 30-51.5]. Symptoms included: cough (69.7%), asthenia (68.8%), anosmia (64.8%), headaches (64.6%), myalgia (62.7%), gastrointestinal symptoms (61.8%), fever (61.5%), and ageusia (60.8%). Mean duration of disease was 27 days (95%CI: 25-29). The rate of persistent symptoms was 46.8% at day 30 and 6.5% at day 60 consisting in asthenia (32.6%), anosmia (32.6%), and ageusia (30.4%). The probability of complete recovery was 56.3% (95%CI: 51.7-61.1) at day 30 and 85.6% (95%CI: 81.2-89.4) at day 60. Factors associated with persistent symptoms were age >40 (HR 0.61), female sex (HR 0.70), low cycle threshold (HR 0.78), and ageusia (HR 0.59). Conclusions. COVID-19 — even in its mild presentation — led to persistent symptoms (up to one month) in nearly half of individuals. Identification of risk factors such as age, gender, ageusia and viral load is crucial for clinical management and argues for the development of antiviral agents