JACC. Case reports · 2025
Giant Thrombus on the Left Atrial Posterior Wall Following Pulsed-Field and Radiofrequency Ablation.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Nakamura Kohki, Sasaki Takehito, Masuyama Taiki, Minami Kentaro, Yoshimura Shingo, Nishiuchi Suguru, Hattori Kojiro, Kodama Akiko, Kaseno Kenichi, Naito Shigeto
Аннотация
BACKGROUND: Thrombus formation on the left atrial (LA) posterior wall (LAPW) after atrial fibrillation (AF) catheter ablation is extremely rare.
CASE SUMMARY: We report a 58-year-old man with persistent AF and dilated cardiomyopathy who underwent pulmonary vein isolation and LAPW ablation mainly with pulsed-field energy and sparingly with radiofrequency energy under continuous low-dose dabigatran. Six months post ablation, despite continuous oral anticoagulation and largely maintaining sinus rhythm, a >50-mm sessile, lobulated mass attached to the LAPW was detected.
DISCUSSION: The LAPW mass regressed with high-dose dabigatran, suggesting that the mass was a thrombus.
TAKE-HOME MESSAGE: This case report highlights that pulsed-field ablation with radiofrequency ablation of the LAPW can rarely lead to a giant LAPW thrombus in patients with persistent AF, severe left ventricular dysfunction, and an enlarged LA with a reduced LA-emptying fraction, and intensified oral anticoagulation may be necessary to manage the postablation thrombus.
CASE SUMMARY: We report a 58-year-old man with persistent AF and dilated cardiomyopathy who underwent pulmonary vein isolation and LAPW ablation mainly with pulsed-field energy and sparingly with radiofrequency energy under continuous low-dose dabigatran. Six months post ablation, despite continuous oral anticoagulation and largely maintaining sinus rhythm, a >50-mm sessile, lobulated mass attached to the LAPW was detected.
DISCUSSION: The LAPW mass regressed with high-dose dabigatran, suggesting that the mass was a thrombus.
TAKE-HOME MESSAGE: This case report highlights that pulsed-field ablation with radiofrequency ablation of the LAPW can rarely lead to a giant LAPW thrombus in patients with persistent AF, severe left ventricular dysfunction, and an enlarged LA with a reduced LA-emptying fraction, and intensified oral anticoagulation may be necessary to manage the postablation thrombus.