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Atrial thrombi occurring during sinus rhythm in cardiac amyloidosis: evidence for atrial electromechanical
S Dubrey1, A Pollak, M Skinner
1Boston University School of Medicine, Section of Cardiology, Massachusetts 02118, USA.
Insights
Cardiac amyloidosis can cause rare left atrial thrombi in patients with sinus rhythm. Impaired atrial function due to severe amyloid infiltration may necessitate anticoagulation therapy.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Left atrial thrombus formation is uncommon in patients maintaining sinus rhythm.
- Cardiac amyloidosis is a progressive condition characterized by amyloid protein deposition in the heart muscle.
- Understanding the mechanisms of thrombus formation in specific cardiac conditions is crucial for patient management.
Observation:
- Transthoracic echocardiography revealed large left atrial thrombi in three patients with extensive cardiac amyloidosis.
- These thrombi were located within or protruded into the main body of the left atrium.
- Patients were in sinus rhythm at the time of echocardiographic examination.
Findings:
- Doppler studies indicated an absence of the A wave in mitral inflow, suggesting impaired atrial contraction.
- Severe infiltration of the atria and ventricles by amyloid was observed.
- Mechanical atrial standstill, likely due to amyloid infiltration, is hypothesized as the cause of thrombus formation.
Implications:
- Severe cardiac amyloidosis can lead to atrial standstill and subsequent thrombus formation, even in sinus rhythm.
- Patients with significant cardiac amyloidosis and impaired atrial function may benefit from anticoagulation.
- This highlights the importance of echocardiographic assessment and risk stratification in cardiac amyloidosis patients.
Abstract:
Thrombus formation in the left atrium is rare in patients in sinus rhythm. In three patients with extensive cardiac amyloidosis transthoracic echocardiography showed large atrial thrombi in or protruding into the body of the left atrium during sinus rhythm. Doppler studies showed no A wave on mitral inflow. Severe atrial and ventricular infiltration by amyloid may have resulted in mechanical atrial standstill with resultant thrombus formation. These findings suggest that patients with severe cardiac amyloidosis may require anticoagulation when atrial function is impaired.