[Atrial thrombosis following the low-energy DC internal countershock of chronic AF: considerations of a clinical...

Area of Science:

• Cardiology
• Cardiac Electrophysiology

Background:

• Embolism risk persists after cardioversion for atrial arrhythmias like atrial fibrillation, even when pre-existing thrombus is absent.
• Atrial stunning and de novo thrombus formation post-cardioversion are proposed mechanisms for embolic events.

Observation:

• A case of chronic atrial fibrillation treated with low-energy internal cardioversion.
• Recurrent heart failure episodes preceded cardioversion.
• A de novo left atrial appendage thrombus formed post-cardioversion, monitored via transesophageal echocardiograms.

Findings:

• The patient developed a new left atrial appendage thrombus after cardioversion.
• No clinical signs of thromboembolism were observed.
• The de novo thrombus resolved spontaneously, confirmed by echocardiography.

Implications:

• This case highlights the potential for de novo thrombus formation after cardioversion, even in the absence of pre-existing thrombus.
• Spontaneous regression of such thrombi is possible, suggesting a dynamic process.
• Further research is needed to understand the mechanisms and clinical significance of post-cardioversion de novo thrombus formation.