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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Left Atrial Appendage Thrombus Despite Anticoagulation

Viorel G Florea1, Venkatakrishna N Tholakanahalli1, Selcuk A Adabag1

  • 1Section of Cardiology, Minneapolis Veterans Affairs Health Care System.

Journal of Atrial Fibrillation
|May 13, 2017
PubMed

Insights

Despite adequate anticoagulation, left atrial appendage thrombi were found in patients undergoing cardioversion. Transesophageal echocardiography before cardioversion may improve safety for atrial fibrillation patients.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine

Background:

  • Current guidelines recommend 3 weeks of anticoagulation before cardioversion for atrial fibrillation (AF) of unknown or long duration.
  • Atrial fibrillation and heart failure are significant cardiovascular epidemics with shared risk factors and accelerated progression.
  • The interplay between AF and heart failure involves complex hemodynamic, neuro-hormonal, inflammatory, and electrophysiologic mechanisms.

Observation:

  • A case report identified left atrial appendage thrombi despite adherence to recommended anticoagulation protocols.
  • This finding challenges the established practice guidelines for cardioversion in atrial fibrillation.

Findings:

  • Adequate anticoagulation may not always prevent thrombus formation in the left atrial appendage.
  • Transesophageal echocardiography (TEE) is crucial for detecting thrombi before cardioversion.

Implications:

  • TEE prior to cardioversion may enhance thromboembolic safety, especially in patients with atrial fibrillation.
  • Further research is needed to refine anticoagulation strategies and improve cardioversion safety.
  • Understanding the complex relationship between atrial fibrillation and heart failure is critical for managing these co-existing conditions.

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