title: Left atrial 'sludge' during vagally mediated pause triggered by pulmonary vein antral ablation.
abstract: We report a case of a patient with long-standing persistent atrial fibrillation (AF) who had rapid formation of spontaneous echo-contrast in the left atrium during pulmonary vein antrum isolation set off by a vagally mediated pause despite standard anticoagulation protocol. Spontaneous echo contrast resolved with ventricular pacing, representing visual evidence for dependence of some AF patients with poor atrial transport function on ventricular emptying with potential greater risk of thromboembolism related to a long ventricular pause.
authors: Heart Rhythm Program, Division of Cardiology, Southlake Regional Health Center, Newmarket, ON, Canada. y.khaykin@utoronto.ca
authors: Yaariv
authors: Y
authors: Khaykin
authors: Zaev A
authors: ZA
authors: Wulffhart
authors: Atul
authors: A
authors: Verma
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004452:Echocardiography; D004562:Electrocardiography; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D020521:Stroke / Q000175:diagnosis / Q000209:etiology; D013923:Thromboembolism / Q000150:complications / Q000473:pathology; D014630:Vagus Nerve / Q000503:physiopathology*