SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

Left atrial appendage thrombus detected by intracardiac echocardiography during electrophysiology study

█ Case Report

DOI: 10.26430/CHUNGARICA.2023.53.3.259

Debreceni Dorottya1, Jánosi Kristóf-Ferenc1, Bocz Botond1, Turcsán Márton1, Simor Tamás1, Kupó Péter1
1Szívgyógyászati Klinika, Általános Orvostudományi Kar, Pécsi Tudományegyetem, Pécs
Levelezési cím:
Dr. Debreceni Dorottya, Pécsi Tudományegyetem, Klinikai Központ, Szívgyógyászati Klinika; 7624 Pécs, Ifjúság útja 13.

The authors present the history of 58-year-old woman with heart failure with reduced ejection fraction (HFrEF) non-ischaemic dilated cardiomyopathy (DCM) and hypertension who was scheduled for pulmonary vein isolation (PVI) due to persistent atrial fibrillation. Based on high risk of stroke identified by CHA2DS2-VASc score her on uninterrupted apixaban treatment (5 mg twice daily) before the ablation. According to the protocol used in our centre, the left atrial appendage (LAA) of a patient who was currently in atrial fibrillation at the onset of PVI procedure was checked by intracardiac echocardiography (ICE) before transseptal puncture. ICE confirmed a LAA thrombus of 2×1.5 cm, thus PVI was not performed. Our case report highlights that it is worthwhile to exclude the presence of a LAA thrombus before PVI in patients with ongoing oral anticoagulant treatment, which can be done by ICE in addition to transesophageal ultrasound (TEE) or cardiac CT scans.


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