Intracardiac thrombosis in patients with arrhythmogenic right ventricular cardiomyopathy

Intracardiac thrombus has been reported in anecdotal cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). This prospective study aimed to determine the prevalence, risk factors, and prognosis of intracardiac thrombosis in patients with ARVC.

From February 2004 to August 2013, transthoracic echocardiograms and magnetic resonance imagings were performed in 193 patients with ARVC. The prevalence, risk factors, and prognosis of intracardiac thrombosis were investigated.

Ten intracardiac thrombi were identified in 8 patients (4.1%), the majority (7/10) of which were found in the right ventricular apex. Multivariate analysis showed that female gender and left ventricular dysfunction were independently associated with increased risk for thrombosis in ARVC. All thrombi were eliminated in 3 weeks after anticoagulation therapy without any complication. During a median follow-up time of 38 months (range 2 to 128), no thromboembolism event or sudden death was observed in patients under anticoagulation therapy; however, in patients without anticoagulation therapy, definite pulmonary thromboembolism occurred in 1 and sudden death due to suspected pulmonary thromboembolism was observed in another.

Intracardiac thrombosis may occur in certain patients with ARVC. Female gender and left ventricular dysfunction appeared to be associated with increased risk for thrombosis. Early screening and effective anticoagulation therapy may improve the prognosis.