Case ReportCASE REPORTS AND CLINICAL OBSERVATIONS
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Left Atrial Posterior Wall Thrombus After Posterior Wall Ablation

Shourjo Chakravorty, Sangeeta Shah and Michael L. Bernard
Ochsner Journal June 2020, 20 (2) 209-214; DOI: https://doi.org/10.31486/toj.18.0148

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Schematic of left atrial posterior wall (PW) isolation lesion set. After completion of wide area circumferential ablation set (A), superior and inferior PW linear lesion sets are made to isolate the PW of the left atrium (B).

  • Figure 2.
    Figure 2.

    Electroanatomic voltage map of the left atrium before (A) and after (B) posterior wall isolation. Isolation of the posterior wall is evidenced by the homogenous gray area spanning the pulmonary veins and posterior wall. Ablation lesions are marked by the dots in view B. Note: A color version of this graphic is available at www.ochsnerjournal.org.

  • Figure 3.
    Figure 3.

    Transesophageal echocardiogram shows 15 × 11 mm posterior wall thrombus (arrows).

  • Figure 4.
    Figure 4.

    Electroanatomic voltage map of the left atrium before (A) and after (B) repeat posterior wall isolation. Compared with the first ablation, there was reconnection along the inferior posterior wall lesion set. The light/dark interface marks the boundary of isolated (light) and active (dark) tissue. Red represents areas of electrical isolation. Note: A color version of this graphic is available at www.ochsnerjournal.org.

Tables

  • Table.

    Risk Factors and Pathophysiology for Cardiac Thrombosis

    Risk FactorPathophysiology
    Mitral valve disease (prolapse, stenosis, regurgitation)Enlargement of the left atrial chamber/stasis
    Chronic heart failure low ejection fractionDecreased cardiac output→stasis
    Duration of atrial fibrillation/Recurrence of atrial fibrillationIncreased thrombosis risk
    History of radiofrequency ablationDamaged wall acts as nidus for clot formation
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