title: Intracardiac echocardiography for immediate detection of intracardiac thrombus formation.
abstract: An 85-year-old man with persistent atrial flutter (AFL) with slow ventricular rate of 44/min, causing fatigue and presyncope, was referred for urgent treatment. In spite of thromboembolic risk scale value 4, he had not been treated with anticoagulants because of high risk of bleeding. The decision was made to perform urgent catheter ablation to interrupt and cure AFL. Intracardiac echocardiography probe was placed in the pulmonary artery and visualized left atrial appendage free from thrombus with its proper function. Heparin was administered and AFL stopped during energy application. Intracardiac echocardiography showed immediate thrombus formation in left atrial appendage owing to complete atrial standstill and no retrograde conduction during hemodynamically effective escape nodal rhythm. This case report shows that in patients with sinus node disease effective ablation of AFL with escape rhythm without retrograde conduction to the atria may result in complete 'electrically induced' atrial standstill and immediate thrombus formation.
authors.affiliation: Division of Clinical Electrophysiology, Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Baran
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sikorska
authors.forename: Roman
authors.initials: R
authors.lastname: Piotrowski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kryński
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001282:Atrial Flutter / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D053840:Brugada Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D000075224:Cardiac Conduction System Disease; D009202:Cardiomyopathies / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal; D005221:Fatigue / Q000503:physiopathology; D030342:Genetic Diseases, Inborn / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D006325:Heart Atria / Q000002:abnormalities / Q000601:surgery; D006327:Heart Block / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D013575:Syncope / Q000503:physiopathology; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin