Transesophageal echocardiographic detection of atrial thrombi in patients with nonfibrillation atrial tachyarrhythmias and congenital heart disease
Open accessAbstract
Objectives We hypothesized an association between atrial thrombi and nonfibrillation atrial tachyarrhythmias in patients with congenital heart disease.Background We observed a fatal thromboembolus after direct current cardioversion in an adolescent with atrial flutter and repaired tetralogy of Fallot.Methods Using transesophageal echocardiography, we prospectively studied 19 consecutive patients with congenital heart disease with nonfibrillation atrial tachyarrhythmia (atrial flutter in 18, primary atrial tachycardia in 1) undergoing electrophysiologic procedures (median age 19.6 years, range 7.0 to 53.8; 11 male, 8 female). Transthoracic echocardiograms were available for 17 patients.Results All transesophageal examinations were performed without incident. No atrial thrombi were detected in 11 patients who subsequently had uncomplicated direct current cardioversion. Eight solitary atrial thrombi were detected (incidence 42%). Six thrombi were located in the right atrium (Fontan repair in four patients, Ebstein's malformation repair in two), and two were noted in the left atrium (congenital hypertrophic cardiomyopathy and atrial septal defect repair in one patient each). Transthoracic echocardiograms were available in seven of eight patients with thrombus detected by transesophageal echocardiography, with only one study conclusive for an atrial thrombus. Cardioversion was deferred in six of eight patients with thrombus, and anticoagulation therapy was initiated. Uncomplicated electrophysiologic procedures were conducted in two patients at the time of detection of right atrial thrombus (atrioventricular node ablation in one patient, direct current cardioversion in the other).Conclusions Prothrombin conditions exist in patients with congenital heart disease with nonfibrillation atrial tachyarrhythmias, as indicated by a significant incidence of transesophageally detected atrial thrombi. The need for prophylactic anticoagulation and the safety of pharmacologic or direct current cardioversion are issues that remain unresolved.
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Intracardiac thrombi are common in GUCH patients undergoing cardioversion for AF, but also in patients with atrial tachycardias or atrial flutter.
“Intracardiac thrombi are common in GUCH patients undergoing cardioversion for AF, but also in patients with atrial tachycardias or atrial flutter.970”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [970]
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- Authors
- Feltes, T. F., & Friedman, R. A.
- Affiliations
- Baylor College of Medicine (US)
- Corresponding author
- Feltes, Timothy F.
- ORCID
- Friedman, Richard A.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1994-11
- Volume
- 24
- Issue
- 5
- Pages
- 1365-1370
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2017018518
- Cited by
- 106
- References
- 29
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 8 · 2015: 9 · 2014: 6 · 2013: 6 · 2012: 1
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Keywords
- atrial thrombus, atrial flutter, congenital heart disease, transesophageal echocardiography, electrical cardioversion, anticoagulation, thromboembolism, atrioventricular node ablation, atrial septal defect repair
- MeSH terms
- Adolescent, Adult, Atrial Flutter, Electric Countershock, Female, Heart Atria, Heart Defects, Congenital, Heart Diseases, Humans, Male, Prospective Studies, Risk Factors, Tachycardia, Thrombosis, Catheter Ablation, Echocardiography, Transesophageal
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