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European Journal of Echocardiography 2006 7(5):383-386; doi:10.1016/j.euje.2005.07.004
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Copyright © 2005, The European Society of Cardiology

Plowing the atrium and growing thrombi: Two cases of large atrial thrombi following ablative and surgical procedure for atrial fibrillation

Shemy Carassoa,b,*, Rafael Kupersteina,b, Eli Konenb,c, Michael Gliksona,b and Micha S. Feinberga,b

aHeart Institute, Sheba Medical Center, 52621 Tel Hashomer, Israel
bThe Sackler Faculty of Medicine, Tel Aviv University, Israel
cThe Department of Radiology, Sheba Medical Center, 52621 Tel Hashomer, Israel

Received 10 April 2005; received in revised form 20 June 2005; accepted after revision 7 July 2005.

* Corresponding author. Heart Institute, Sheba Medical Center, 52621 Tel Hashomer, Israel. Tel.: +972 3 530 2433; fax: +972 3 530 2407. carassos{at}netvision.net.il


  Abstract

Aim We present two patients with a large left atrial (LA) thrombus following invasive treatment for atrial fibrillation and inadequate anticoagulation.

Methods and results Case 1: A 30-year-old woman, with a one-year history of symptomatic paroxysmal atrial fibrillation resistant to medical therapy, underwent catheter ablation for atrial fibrillation. Three days after the procedure the patient presented with dizziness, fatigue, rapid atrial fibrillation with a sub-therapeutic INR. Transesophageal echocardiography (TEE) revealed a large LA thrombus. Case 2: A 59-year-old male, with severe mitral regurgitation and chronic atrial fibrillation, underwent mitral valve repair and Cox–Maze procedure. Three months later, while asymptomatic, a follow-up transthoracic echocardiography a large posterior LA thrombus was imaged. His INR was also sub-therapeutic. Both patients were treated by enhancing anticoagulation and close echocardiographic follow-up. So far both patients have remained asymptomatic two months following discharge.

Conclusion Large LA thrombi detected by transthoracic echocardiography are a rare complication of the Cox–Maze procedure and radio-frequency ablation for atrial fibrillation, which may occur even in patients with restored normal sinus rhythm receiving inadequate anticoagulation therapy.

Keywords: Atrial fibrillation; Radio-frequency ablation; Maze procedure; Thrombus


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