1/23. A practical approach to atrial fibrillation.Management of atrial fibrillation is still an individualized proposition, requiring considerable clinical judgment to select the most effective means of controlling cardiac rate and rhythm and preventing thromboembolism and stroke. The advantages and disadvantages of electric shock cardioversion, catheter ablation, and several medicinal and mechanical agents are discussed.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/23. When the body and appendage of the left atrium disagree: "Focal" atrial fibrillation-implications for atrial thrombus formation and risk of thromboembolism.A case is presented of a man who had 5 hours of atrial fibrillation followed by spontaneous conversion and maintained sinus rhythm that persisted as shown by surface electrocardiography. Transesophageal echocardiography performed 24 hours after electrocardiographic conversion documented an atrial fibrillation pattern within the left atrial appendage, with a normal sinus Doppler pattern in the body of the left atrium. This apparent regional discrepancy in atrial function may partially explain the increased risk for "late" thromboembolism among patients with atrial fibrillation who appear to be successfully converted with sustained sinus rhythm.- - - - - - - - - - ranking = 5keywords = thromboembolism (Clic here for more details about this article) |
3/23. Isolated non-compaction of the left ventricle: a rare indication for transplantation.This report describes the diagnostic difficulty encountered in a young female patient presenting with neurologic symptoms, atrial fibrillation and severe left ventricular systolic dysfunction, eventually leading to cardiac transplantation. The scrutiny used in the evaluation of the particular aspect of the left ventricle, and the integration of the information obtained from echocardiography, angiography and magnetic resonance imaging, led to the diagnosis of a rare and mostly unknown cause of cardiac failure. The correct identification of this entity is mandatory because enhanced risk of thromboembolism and malignant arrhythmia should be anticipated. A review of the literature revealed only 6 patients in whom isolated non-compaction of the left ventricle was treated by heart transplantation.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
4/23. Left atrial thrombus causing pulmonary embolism by passing through an atrial septal defect.A 66-year-old woman admitted with dyspnea on exertion had atrial fibrillation and left ventricular dysfunction. echocardiography revealed an atrial septal defect (ASD) and a soft, easily deformable thrombus in the dilated left atrium. The atrial mass suddenly disappeared on the 10th day after admission, and contrast-enhanced chest computed tomography and pulmonary blood flow scintigraphy showed that the thrombus had detached from the left atrium, floated into the right atrium through the ASD and caused pulmonary embolism. This is the first documented case of a left atrial thrombus causing pulmonary embolism by passing through an ASD. When an ASD is present, it is important to consider not only paradoxical thromboembolism (from the right to the left atrium), but also pulmonary embolism caused by thromboembolism from the left to the right atrium.- - - - - - - - - - ranking = 2keywords = thromboembolism (Clic here for more details about this article) |
5/23. Cerebrovascular complication associated with pulmonary vein ablation.INTRODUCTION: Radiofrequency (RF) ablation has become an established treatment modality for patients with paroxysmal atrial fibrillation (AF). A principal limitation of RF catheter ablation is the risk of thromboembolism. stroke as a complication after ablation of triggers of AF has not been previously reported. methods AND RESULTS: Fifty-six patients underwent RF ablation for a focal source of AF. Forty-nine patients (86%) had AF triggers in > or = 1 pulmonary vein. Mean procedure time was 227 /- 74 minutes. Cerebrovascular event occurred in 3 (5%) patients, all >60 years old. Two of the three patients had a prior history of transient ischemic attacks. CONCLUSION: The risk of stroke from RF ablation may be higher in paroxysmal AF patients with prior transient ischemic attack.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
6/23. Decreased left atrial appendage flow velocity with atrial fibrillation caused by negative inotropic agents: report of two cases.Although pharmacological agents are frequently used to control ventricular rate or restore sinus rhythm of patients with atrial fibrillation (AF), there are no reports of the relationship between those agents and left atrial appendage (LAA) function. Two cases of a decrease in LAA blood flow velocity caused by negative inotropic agents are presented as an indication that negative inotropic agents are a risk factor for systemic thromboembolism with AF.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
7/23. Endocardial flap of left atrial dissection following radiofrequency ablation.This report describes an unusual mobile strand found by transesophageal echocardiography prior to a patient's second radiofrequency ablation for paroxysmal atrial fibrillation. This structure arose from the limbus of the left upper pulmonary vein, a location where radiofrequency energy bursts were delivered during the first ablation procedure. After seven months of therapeutic anticoagulation, there was no evidence of change in the size of the mass or of thromboembolism and the patient underwent radiofrequency ablation without complication. We believe this structure most likely represents an endocardial flap of left atrial dissection temporally related to radiofrequency ablation.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
8/23. Off-pump right atrial thrombectomy for heparin-induced thrombocytopenia with thrombosis.This report describes a 72-year-old woman with atrial fibrillation who presented with lower extremity ischemia secondary to thromboembolism. After lower extremity thrombectomy, the patient developed heparin-induced thrombocytopenia with thrombosis (HITT). Her postoperative course was complicated by recurrent supraventricular and ventricular tachycardia, secondary to a mobile thrombus in the right atrium extending into the right ventricle. Because administration of heparin was contraindicated, the patient underwent off-pump right atrial thrombectomy during a brief period of inflow occlusion. Postoperatively, she was placed on lepirudin. Her platelet count normalized without any further thrombotic episodes, and she was discharged on warfarin.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
9/23. Percutaneous isolation of multiple pulmonary veins using an expandable circular cryoablation catheter.Although radiofrequency pulmonary vein (PV) ablation is effective in the treatment of atrial fibrillation (AF), it is associated with small but significant risks of PV stenosis and systemic thromboembolism. The characteristics of cryothermic tissue injury may reduce the likelihood of such complications, but using conventionally tipped cryoablation catheters can be time consuming and may, thus, not permit isolation of all PVs during a single procedure. We describe a case of rapid and effective isolation of all electrically connected PVs in a patient with paroxysmal AF, using a percutaneous self-expanding circular-tipped cryoablation catheter.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
10/23. Management of left atrial endocardium after extensive thrombectomy.thrombosis at the left atrium is a common phenomenon in patients with chronic mitral valve disease and atrial fibrillation. When thrombus organizes and evolves into chronic phase, clean thrombectomy can become a challenge during heart surgery because of dense adhesions and the lack of clean cleavage plane. Leaving residual thrombotic material or roughened endocardial surface after thrombectomy could be a potential source for further thrombosis and a nidus for thromboembolism. We recently managed such a patient successfully using extensive thrombectomy and endocardial coverage with a fresh autologous pericardial patch.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
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