Abstract
We present a case of a 60 year old male who found to be in atrial
fibrillation during routine evaluation. Anticoagulation was initiated
for 36 hours and he was referred for TEE guided electrical
cardioversion. There was no thrombus identified in the left atrial
appendage, however the appendage was large and had a tongue like
accessory lobe along with spontanous contrast on the left atrium and its
appendage. TEE probe was not withdrawn, patient underwent successful
cardioversion with 200 joules and developed a thrombus in the left
atrial appendage immediately after cardioversion, which rapidly became
more dense. There was an associated marked decrease in appendage
velocities. Patient was hospitalized to initiate low molecular weight
heparin.
This case highlights the need for vigilance in patients with unknown
duration of atrial fibrillation, who have received a short duration of
anticoagulant therapy and who have adverse appendage anatomy as thrombus
may develop immediately after cardioversion despite anticoagulation.
Key words: atrial fibrillation, left atrial appendage, cardioversion,
transesophageal echocardiography, appendage thrombus
Herein we present an isolated patient teaching case in whom informed
consent was waived by the institutional policy. A verbal consent was
obtained from the patient about anonymous publishing of the case at the
time of the procedure due to its teaching value.