JACC. Case reports · 2026
Acute Postcardioversion Left Atrial Appendage Stasis During Left Atrial Appendage Closure Procedures.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Ivanov Alexander, Mohananey Divyanshu, Meskin Joshua, Berger Marcie
Аннотация
BACKGROUND: Acute postcardioversion left atrial appendage (LAA) low-flow states are recognized but likely underdetected, as repeat appendage imaging is not routine after sinus restoration.
CASE SUMMARY: Three patients undergoing left atrial appendage closure (LAAC) developed new LAA spontaneous echo contrast, dense spontaneous echo contrast/sludge, or a persistent filling defect suspicious for thrombus within minutes of cardioversion. Ultrasound enhancing agent distinguished slow complete opacification from a persistent filling defect, guiding individualized deploy-vs-abort decisions.
DISCUSSION: LAAC uniquely permits appendage imaging immediately before and after cardioversion, and serial intraprocedural transesophageal echocardiography offers a rarely available window on acute LAA stasis. Alternative contributors, including ablation, transseptal instrumentation, and anticoagulation strategy, warrant consideration, particularly in combined atrial fibrillation ablation/LAAC workflows. Prospective studies should define prevalence, risk markers, and mitigation strategies.
TAKE-HOME MESSAGE: Serial transesophageal echocardiography during LAAC can reveal acute postcardioversion LAA stasis; ultrasound enhancing agent can differentiate slow flow from thrombus and guide individualized deploy-vs-abort decisions.
CASE SUMMARY: Three patients undergoing left atrial appendage closure (LAAC) developed new LAA spontaneous echo contrast, dense spontaneous echo contrast/sludge, or a persistent filling defect suspicious for thrombus within minutes of cardioversion. Ultrasound enhancing agent distinguished slow complete opacification from a persistent filling defect, guiding individualized deploy-vs-abort decisions.
DISCUSSION: LAAC uniquely permits appendage imaging immediately before and after cardioversion, and serial intraprocedural transesophageal echocardiography offers a rarely available window on acute LAA stasis. Alternative contributors, including ablation, transseptal instrumentation, and anticoagulation strategy, warrant consideration, particularly in combined atrial fibrillation ablation/LAAC workflows. Prospective studies should define prevalence, risk markers, and mitigation strategies.
TAKE-HOME MESSAGE: Serial transesophageal echocardiography during LAAC can reveal acute postcardioversion LAA stasis; ultrasound enhancing agent can differentiate slow flow from thrombus and guide individualized deploy-vs-abort decisions.