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Patients with atrial fibrillation (AF) undergoing either pulmonary vein isolation (PVI) or direct current cardioversion (DCCV) most commonly undergo transoesophageal echocardiography (TOE) for definite exclusion of a thrombus in the left atrial appendage (LAA).1 As TOE as a semi-invasive procedure is not without risk to the patient and during the current times with a still ongoing SARS-Cov-2 pandemic for the clinician, a definite exclusion of LAA thrombosis before a PVI or DCCV using a readily available biomarker would minimise the risk for the patient and clinician alike. However, as far as now the quest to identify such a biomarker is still ongoing.
D-dimer levels in the ADDIT-AF Study and identification of patients with LAA thrombus
In their manuscript Almorad et al 2 did compare two cut-offs of D-dimer to exclude LAA thrombus before DCCV. In their study patients did receive a transthoracic echocardiography 6 months before the TOE and D-dimer levels were measured at the day of the DCCV. Two cut-offs were used in the study, the first being 500 ng/mL as suggested by the manufacturer of the test and the second being an age-adjusted value 10 times the patients age.2 The main finding was that both cut-offs were able to identify the 13 patients with LAA thrombus whereby the age-adjusted cut-off had a higher specificity with 66.4% to 50.4% for the standard …
Footnotes
Contributors CRS is the sole author of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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