Thrombus in the left atrial appendage detected by intracardiac echocardiography

  • M.R.M. Jongbloed
  • J.J. Bax
  • E.E. van der Wall
  • M.J. Schalij


Radiofrequency catheter ablation (RFCA) at the ostium of the pulmonary veins can potentially cure atrial fibrillation. Left-sided ablation procedures may carry a risk of thrombo-embolic events. Emboli from intracardiac thrombus originate from the left atrial appendage (LAA) in a substantial number of patients. The presence of spontaneous echo contrast in the left atrium (LA) and LAA peak emptying flow ≤ 20 cm/s are also significantly related to thrombo-embolic events. Evaluation of the anatomy of the LA and LAA prior to left-sided procedures is therefore mandatory. Intracardiac echocardiography (ICE) appears an ideal technique to obtain this information during the RFCA-procedure. In the current report, we report on the use of ICE detecting a thrombus in the LAA in a patient planned to undergo RFCA of pulmonary veins for atrial fibrillation.

atrial fibrillation intracardiac echocardiography left atrial appendage pulmonary veins thrombus 


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  1. 1.
    Al Saady NM, Obel OA, Camm AJ. Left atrial appendage: structure, function, and role in thromboembolism. Heart 1999; 82(5): 547-554.Google Scholar
  2. 2.
    Antonielli E, Pizzuti A, Palinkas A, et al. Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. J Am Coll Cardiol 2002; 1443-1449.Google Scholar
  3. 3.
    Agmon Y, Khandheria BK, Meissner I, et al. Left atrial appendage flow velocities in subjects with normal left ventricular function. Am J Cardiol 2000; 86(7): 769-773.Google Scholar
  4. 4.
    Thijssen VL, Ausma J, Borgers M. Structural remodelling during chronic atrial fibrillation: act of programmed cell survival. Cardiovasc Res 2001; 52(1): 14-24.Google Scholar
  5. 5.
    Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92(7): 1954-1968.Google Scholar
  6. 6.
    Agmon Y, Khandheria BK, Gentile F, Seward JB. Echocardiographic assessment of the left atrial appendage. J Am Coll Cardiol 1999; 34(7): 1867-1877.Google Scholar
  7. 7.
    Pollick C, Taylor D. Assessment of left atrial appendage function by transesophageal echocardiography. Implica-Figure 2. The left atrial appendage. An echodense mass is present, suspect for thrombus. LA-left atrium, LAA-left atrial appendage. tions for the development of thrombus. Circulation 1991; 84(1): 223-231.Google Scholar
  8. 8.
    Ozer N, Tokgozoglu L, Ovunc K, et al. Left atrial appendage function in patients with cardioembolic stroke in sinus rhythm and atrial fibrillation. J Am Soc Echocardiogr 2000; 13(7): 661-665.Google Scholar
  9. 9.
    Kamp O, Verhorst PM, Welling RC, Visser CA. Importance of left atrial appendage flow as a predictor of thromboembolic events in patients with atrial fibrillation. Eur Heart J 1999; 20(13): 979-985.Google Scholar
  10. 10.
    Morton JB, Sanders P, Sparks PB, Morgan J, Kalman JM. Usefulness of phased-array intracardiac echocardiography for the assessment of left atrial mechanical 'stunning' in atrial flutter and comparison with multiplane transesophageal echocardiography(*). Am J Cardiol 2002; 90(7): 741-746.Google Scholar
  11. 11.
    Tani T, Yamakami S, Matsushita T, et al. Usefulness of electron beam tomography in the prone position for detecting atrial thrombi in chronic atrial fibrillation. J Comput Assist Tomogr 2003; 27(1): 78-84.Google Scholar
  12. 12.
    Mangrum JM, Mounsey JP, Kok LC, DiMarco JP, Haines DE. Intracardiac echocardiography-guided, anatomically based radiofrequency ablation of focal atrial fibrillation originating from pulmonary veins. J Am Coll Cardiol 2002; 39(12): 1964-1972.Google Scholar
  13. 13.
    Saad EB, Marrouche NF, Saad CP, et al. Pulmonary vein stenosis after catheter ablation of atrial fibrillation: emergence of a new clinical syndrome. Ann Intern Med 2003; 138(8): 634-638.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • M.R.M. Jongbloed
    • 1
  • J.J. Bax
    • 1
  • E.E. van der Wall
    • 1
  • M.J. Schalij
    • 1
  1. 1.Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands

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