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Revolving thrombus within the left atrium at atrial fibrillation ablation

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

Abstract

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.

Keywords

Pulmonary vein isolation Transseptal puncture Thrombus Heparin Thromboembolic events 

Flottierender Thrombus im linken Vorhof während Pulmonalvenenisolation

Zusammenfassung

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.

Schlüsselwörter

Pulmonalvenenisolation Transseptale Punktion Thrombus Heparin Thrombembolischen 

Notes

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)

References

  1. 1.
    January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekovitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CV (2014) AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64(21):e1–e76CrossRefPubMedGoogle Scholar
  2. 2.
    Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E (2010) Update worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 3(1):32–38CrossRefPubMedGoogle Scholar
  3. 3.
    Demolin JM, Eick OJ, Munch K, Koullick E, Nakagawa H, Wittkampf FHM (2002) Soft thrombus formation in radiofrequency catheter ablation. Pacing Clin Electrophysiol 25:1219–1222CrossRefPubMedGoogle Scholar
  4. 4.
    Wazni O, Rossillo A, Marrouche NF, Saad EB, Martin DO, Bhargava M, Bash D, Beheiry S, Wexman M, Potenza D, Pisano E, Faneli F, Bonso A, Themistoclakis S, Erciyes D, Saliba WI, Schweikert RA, Brachmann J, Raviele A, Natale A (2005) Embolic events and char formation during pulmonary vein isolation in patients with atrial fibrillation: impact of different anticoagulation regimens and importance of intracardiac echo imaging. J Cardiovasc Electrophysiol 16:576–581CrossRefPubMedGoogle Scholar
  5. 5.
    Okuyama Y, Kashiwase K, Mizuno H, Oka T, Takeda Y, Komatsu S, Hirayama A, Kodama K (2006) Development of thrombus on a transseptal sheath in the left atrium during attempted electrical pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation. Europace 8:191–192CrossRefPubMedGoogle Scholar
  6. 6.
    Bruce CJ, Friedman PA, Narayan O, Munger TM, Hammill SC, Packer DL, Asirvatham SJ (2008) Early heparinization decreases the incidence of left atrial thrombi detected by intracardiac echocardiography during radiofrequency ablation for atrial fibrillation. J Interv Card Electrophysiol 22:211–219CrossRefPubMedGoogle Scholar

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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