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Course of intraatrial thrombi resolution using transesophageal echocardiography
Jennifer A Larsen1, David D McPherson, Alan H Kadish
1Division of Cardiology, Northwestern University Medical School, 251 E. Huron Street, Chicago, IL 60611, USA.
Insights
Intraatrial thrombi often persist despite anticoagulation, posing risks during cardioversion for atrial fibrillation. Further research is needed to predict embolic events and guide treatment strategies.
Area of Science:
- Cardiology
- Cardiac Imaging
Background:
- Thromboembolic events are a known complication of atrial fibrillation and cardioversion.
- Standard anticoagulation protocols prior to cardioversion may not be sufficient for thrombus resolution.
Purpose of the Study:
- To investigate the resolution rates of intraatrial thrombi in patients undergoing serial transesophageal echocardiograms (TEE).
- To assess the association between persistent thrombi and cardioversion outcomes.
Main Methods:
- Retrospective analysis of 25 patients with initial intraatrial thrombi identified by TEE.
- Follow-up TEE performed at a mean of 4 months to assess thrombus persistence.
- Correlation of thrombus persistence with clinical factors and cardioversion outcomes.
Main Results:
- Persistent intraatrial thrombi were observed in 76% of patients (19/25) at follow-up TEE.
- Mitral valve disease and atrial fibrillation were associated with persistent thrombi.
- One patient (14%) with persistent thrombi experienced a neurologic event after cardioversion.
Conclusions:
- Intraatrial thrombi frequently do not resolve with standard anticoagulation periods.
- Persistent left-sided thrombi may increase embolic risk following cardioversion.
- Identifying predictors of embolic events in patients with persistent thrombi is crucial for guiding cardioversion strategies.
Abstract:
Thromboembolic events are associated with atrial fibrillation and with cardioversion to sinus rhythm. Although studies have demonstrated the risk of this complication is reduced by a 3-week period of anticoagulation prior to cardioversion, limited data have suggested a longer period of anticoagulation is necessary for thrombus resolution. We identified and followed 25 patients noted to have intraatrial thrombi on an initial transesophageal echocardiogram (TEE) who subsequently had a follow-up TEE. The majority of patients had a single thrombus, often but not uniformly located in the left atrial appendage with the largest found in those patients with mitral stenosis. Repeat TEE was performed at a mean of 4 +/- 6 months and persistent thrombus was noted in 19 of 25 patients (76%). Seven of 19 patients with persistent thrombi were cardioverted and one of these patients had a neurologic event following the procedure (14%). The only findings associated with persistent thrombus were the presence of mitral valve disease and atrial fibrillation. Our findings suggest that intraatrial thrombi do not generally resolve following several weeks of anticoagulation and that persistent left-sided intraatrial thrombi may be associated with an increased risk for events following cardioversion. Given that a TEE-guided approach to cardioversion is being utilized more frequently, it may be important to determine thrombus characteristics on follow-up that would be predictive of embolic events following cardioversion.