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[Electrical cardioversion and thrombogenesis. Apropos a case]
N Basterra Sola1, F Olaz Preciado, F Ruiz Mateas
1Servicio de Cardiología, Hospital de Navarra, Pamplona.
Insights
A transesophageal echocardiography before cardioversion for atrial fibrillation showed no thrombus. However, a left atrial appendage thrombus formed after the procedure despite anticoagulation, raising questions about its necessity.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia requiring treatment.
- Direct current cardioversion (DCCV) is a procedure to restore normal heart rhythm.
- Transesophageal echocardiography (TEE) is used to screen for atrial thrombus before DCCV.
Observation:
- A 73-year-old patient with AF underwent DCCV.
- Pre-procedural TEE revealed no evidence of atrial thrombus.
- Post-procedural TEE detected a new thrombus in the left atrial appendage.
Findings:
- Thrombus formation occurred in the left atrial appendage after DCCV.
- The thrombus developed despite the patient receiving oral anticoagulation therapy.
- This case challenges the standard protocol regarding pre-cardioversion anticoagulation.
Implications:
- The findings suggest a potential need to re-evaluate the role and timing of oral anticoagulation in AF patients undergoing DCCV.
- Further research is warranted to understand the mechanisms of post-cardioversion thrombus formation.
- This case highlights the importance of vigilant monitoring even after successful cardioversion.
Abstract:
We report a case of a 73-years-old patient with atrial fibrillation who underwent direct current cardioversion. The transesophageal echocardiography performed before cardioversion excluded the presence of atrial thrombus. After cardioversion a new transesophageal echocardiography detected a thrombus in the left atrial appendage despite oral anticoagulation. Mechanism of thrombus formation and the need for oral anticoagulation before the procedure is being discussed.