Safety evaluation of electrical cardioversion in the presence left ventricular thrombus
M Marwan Dabbagh1, Saqer Alkharabsheh2, Mohamed Khayata2
1Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Insights
Cardioversion in patients with left ventricular thrombus (LVT) appears safe, with no embolic complications observed in this study. Further research is recommended to confirm these findings for electrical cardioversion safety.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Electrical cardioversion is a standard treatment for various cardiac arrhythmias.
- Left atrial thrombus is a known contraindication for cardioversion.
- Limited data exists on the safety of cardioversion in patients with left ventricular thrombus (LVT).
Purpose of the Study:
- To evaluate the safety of electrical cardioversion in patients diagnosed with left ventricular thrombus (LVT).
Main Methods:
- Retrospective review of patients diagnosed with LVT via transthoracic echocardiogram (TTE) between 2010 and 2019.
- Inclusion criteria: TTE showing LVT within 4 weeks prior or 2 days after cardioversion.
- Follow-up for embolic events within three months post-cardioversion.
Main Results:
- 39 patients with LVT underwent cardioversion.
- Mean ejection fraction was 24%.
- No embolic complications were reported during the 81-day follow-up period.
Conclusions:
- Cardioversion in patients with LVT may be a safe procedure.
- Larger studies are necessary to validate these findings and establish definitive safety guidelines.
Background:
Electrical cardioversion is an effective and safe procedure for most patients. While left atrial thrombus is an absolute contraindication for an elective cardioversion, there is limited data on cardioversion in patients with left ventricular thrombus (LVT). We sought to better study the safety of cardioversion in this population.
Methods:
We retrospectively reviewed all patients with the diagnosis of LVT on transthoracic echocardiogram (TTE) at our institution from 2010 to 2019. Patients were included in the study if they had undergone cardioversion and had had a TTE 4 weeks prior or 2 days after cardioversion showing left ventricular thrombus. Medical charts were reviewed for embolic events within three months after cardioversion.
Results:
Out of 764 patients, 39 were included in the study. The mean age was 60 ± 14 years. The reasons for cardioversion were atrial fibrillation/flutter (n = 14), ventricular arrhythmia (n = 14), and defibrillation threshold testing during defibrillator placement (n = 11). The mean time interval between the TTE and the cardioversion was 6 ± 6.3 days. The mean left ventricular ejection fraction was 24 %±10 %. The LVT was mobile (n = 3), fixed (n = 36). During a clinical follow-up period of 81±17 days, 29 patients (74 %) were treated with warfarin, 2 patients (5 %) with a direct oral anticoagulant, and 8 patients (21 %) with antiplatelet therapy alone. No patient had an embolic complication during the follow-up.
Conclusion:
Within the limitations of this study, cardioversion in patients with LVT appeared to be safe. Further larger studies are needed.
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