Revolving thrombus within the left atrium at atrial fibrillation ablation

  • Mauro TonioloEmail author
  • Alejandro Estrada
  • David Filgueiras-Rama
  • Josè L. Merino
Case Report


A 68-year-old man was referred for pulmonary vein (PV) isolation. Access to the left atrium was obtained via a single transseptal puncture. A heparin bolus was given immediately after puncture. Angiography of the left PV was performed. After the contrast wash-out, a contrasted longitudinal thrombus was shown revolving within the left atrium for several seconds before being expelled through the mitral and aortic valves. It is common practice in these procedures to administer an intravenous bolus of heparin immediately after the transseptal puncture. However, heparin has latency to become effective, and this can result in thromboembolic events.


Pulmonary vein isolation Transseptal puncture Thrombus Heparin Thromboembolic events 

Flottierender Thrombus im linken Vorhof während Pulmonalvenenisolation


Ein 68-jähriger Mann wurde zur Pulmonalvenenisolation überwiesen. Es erfolgte eine einfache transseptale Punktion mit unmittelbar darauffolgender i. v. Heparingabe. Die linken Pulmonalvenen wurden angiographisch dargestellt. Im Laufe des Kontrastmittel-wash outs wurde ein Thrombus festgestellt, der zunächst für einige Sekunden im linken Vorhof flottierte und dann durch Mitral- und Aortenklappe in den Systemkreislauf gelangte. Bei linksatrialen Prozeduren ist es üblich, einen Heparinbolus unmittelbar nach transseptaler Punktion zu verabreichen. Allerdings weist Heparin eine gewisse Wirkungslatenz auf, was zu thrombembolischen Ereignissen führen kann.


Pulmonalvenenisolation Transseptale Punktion Thrombus Heparin Thrombembolischen 


Compliance with ethical guidelines

Conflict of interest

Dr. J.L. Merino is consultant to Magnetecs, Inc. and receives honoraria payment for providing medical and technical training for St. Jude Medical. All other authors have no conflicts of interest to declare.

The accompanying manuscript does not include studies on humans or animals.

Supplementary material

(MOV Video 3115 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Mauro Toniolo
    • 1
    • 2
    Email author
  • Alejandro Estrada
    • 1
  • David Filgueiras-Rama
    • 1
  • Josè L. Merino
    • 1
  1. 1.Arrhythmia and Robotic Cardiac Electrophysiology Unit, IdiPazHospital Universitario “La Paz”MadridSpain
  2. 2.Division of CardiologyUniversity Hospital “S.Maria della Misericordia”UdineItaly

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