Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography
Jian-Fang Ren, MD, FACC*,*,
Francis E. Marchlinski, MD, FACC* and
David J. Callans, MD, FACC*
* Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania, USA
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Figure 1 Intracardiac echocardiography images with the transducer (7.5 MHz) placed in the right atrium (RA) demonstrate spontaneous echo contrast, as slowly swirling amorphous echoes in a dilated (diameter = 5.2 cm) left atrium (LA) (left panel). Slowly swirling non-homogeneous echoes become more prominent during sheath flushing with heparinized solution (right panel).
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Figure 2 Intracardiac echocardiography images with transducer placed in the right atrium (RA) demonstrate a single, linear, and mobile thrombus (arrow, size 7.9 x 4.2 mm) attached at the sheath of lasso (left upper panel), pulling the sheath/lasso with thrombus back (right upper panel) and withdrawal of thrombus from the left atrium (LA) (left lower panel) into the RA (right lower panel). Ao = aorta; LV = left ventricle. Other abbreviations as in Figure 1.
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Figure 3 Intracardiac echocardiography images demonstrate LA thrombus (size 4.0 x 3.9 mm2) wedged in the interatrial septum (left panel) and reduced in size (2.8 x 2.0 mm2) under anticoagulation with follow-up images after 24 h (right panel). Abbreviations as in Figure 1.
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