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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Published on: February 26, 2013

Missing left atrial thrombus: dislodgement or artifact?

Kazuhiro Kurisu¹, Manabu Hisahara, Yusuke Ando

¹Department of Cardiovascular Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. byou-iryou-cvs@city.kitakyushu.lg.jp

The Annals of Thoracic Surgery

|August 30, 2008

Summary

Patients with left atrial thrombus face high thromboembolism risk, often needing surgery. A case revealed no thrombi during surgery despite prior embolism, highlighting echocardiography artifact risks.

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Area of Science:

Cardiology
Neurology
Medical Imaging

Background:

Left atrial thrombus is a significant risk factor for thromboembolic events, particularly stroke.
Surgical intervention is often the recommended treatment for patients with left atrial thrombi.
Chronic atrial fibrillation increases the likelihood of thrombus formation and subsequent embolism.

Observation:

A patient with a history of cerebral embolism due to chronic atrial fibrillation underwent thrombectomy.
Unexpectedly, no left atrial thrombi were detected during the thrombectomy procedure.
This case challenges the routine assumption of thrombus presence in high-risk patients.

Findings:

Echocardiography is a primary diagnostic tool for identifying left atrial thrombi.
Reverberation artifacts on echocardiography can mimic or obscure the presence of thrombi.
The study highlights the potential for false-positive or false-negative findings in echocardiographic assessments.

Implications:

Clinicians should consider the possibility of echocardiographic artifacts when evaluating for left atrial thrombi.
Further investigation may be warranted in cases with discordant clinical and imaging findings.
Accurate thrombus detection is crucial for appropriate treatment decisions and preventing thromboembolic events.