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[Right atrial appendage thrombosis during atrial fibrillation: an element to look for]
Giovanni Barbati1, Renato De Domenico1, Stefania Rossi2
1S.C. Cardiologia, Ospedale San Bassiano, Bassano del Grappa (VI).
Insights
In atrial fibrillation (AF) patients, even after left atrial appendage closure, right atrial appendage thrombosis can occur. This case highlights the need to screen for right atrial thrombosis in AF patients.
Area of Science:
- Cardiology
- Neurology
- Thrombosis Research
Background:
- Oral anticoagulant therapy (OAT) is a primary treatment for atrial fibrillation (AF).
- Left atrial appendage closure is an alternative for AF patients with intracerebral hemorrhage on OAT.
- Right atrial appendage thrombosis is a potential complication in AF patients.
Observation:
- A patient with chronic AF presented with syncope due to orthostatic hypotension.
- The patient had previously undergone left atrial appendage closure due to intracerebral hemorrhage while on OAT.
- Right atrial appendage thrombosis was identified in this patient.
Findings:
- OAT was resumed with apixaban 5 mg twice daily.
- Transesophageal echocardiography confirmed complete resolution of right atrial appendage thrombosis after two months.
- The case demonstrates a rare instance of right atrial appendage thrombosis in an AF patient.
Implications:
- This case emphasizes the importance of screening for right atrial appendage thrombosis in AF patients.
- Left atrial appendage closure may not entirely prevent thromboembolic events in AF patients.
- Further research is needed to understand the risks and management of right atrial appendage thrombosis in AF.
Abstract:
Oral anticoagulant therapy (OAT) is a mainstay of atrial fibrillation (AF) pharmacological treatment. Left atrial appendage closure is a possible treatment, when feasible, in patients with intracerebral hemorrhage during OAT. We report a case of right atrial appendage thrombosis in a patient with chronic AF admitted for syncope due to diuretic-induced orthostatic hypotension. Two years previously, he had undergone left atrial appendage closure with the Amplatzer Cardiac Plug device because of intracerebral hemorrhage during OAT. After neurological consult, OAT was resumed with apixaban 5 mg twice daily, and transesophageal echocardiography performed two months later showed complete resolution of the right atrial appendage thrombosis. This particular case underlines the importance of searching for a possible right atrial appendage thrombosis in patients affected by AF, and suggests that left atrial appendage closure in AF patients not suitable for OAT does not fully eliminate the risk of thromboembolism.